title: Recent hospitalization and the risk of hip fracture among older Americans.
abstract: BACKGROUND
  We identified hip fracture risks in a prospective national study.
  
  
  METHODS
  Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.
  
  
  RESULTS
  A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).
  
  
  CONCLUSIONS
  Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.
authors.affiliation: University of Iowa, 200 Hawkins Drive, E-205 General Hospital, Iowa City, IA 52242, USA. fredric-wolinsky@uiowa.edu
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Maksym
authors.initials: M
authors.lastname: Obrizan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cook
authors.forename: Kara B
authors.initials: KB
authors.lastname: Wright
authors.forename: John F
authors.initials: JF
authors.lastname: Geweke
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Claire E
authors.initials: CE
authors.lastname: Pavlik
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Richardson
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology