Changes in population demographics and the future incidence of hip fracture.
BACKGROUND
During the first three decades of the 21st century the combination of increasing life expectancy and falling birth rates will result in substantial demographic changes within the population of the United Kingdom. A large increase in the elderly population is likely to have significant effects on the number of patients who sustain a hip fracture.


OBJECTIVE
To predict future changes in hip fracture burden in Scotland.


METHODS
Data was obtained from the Scottish Hip Fracture Audit database for a 12 month period between April 2004 and March 2005. All orthopaedic units in Scotland participated in the audit during this period. This data was used to calculate the incidence of hip fracture by 5 year age/gender cohorts. Outcome data was analysed in a similar manner. Population prediction data obtained from the Registrar General's Office was then used to predict hip fracture numbers for the year 2031. Two separate prediction models were used. The first model assumed that the age/gender specific incidence of hip fracture observed in 2004 would remain constant. Between 1999 and 2004, a 9.6% decrease in the population incidence of hip fracture was observed. Therefore a second prediction model was used which assumed a continuation in the fall in population incidence of hip fracture between 2004 and 2031.


RESULTS
The population aged 50 years and above is predicted to increase 28% by 2031, with the most significant increases occurring in the over 1980s. The number of hip fractures is predicted to rise by 45% to 75% (from 6164 to 8829-10756 cases per annum) requiring an additional 287-474 hospital beds. By 2031 approximately 45% of fractures will occur in those aged 85 years and above, compared to 34% in 2004. Predicted changes in population demographics are highly variable by region and so local planning of resource provision will be essential.


CONCLUSIONS
Changes in population demographics will have significant implications for health care provision for the care of hip fracture patients. An increase in the capacity of acute orthopaedic care and a review of care models will be required to ensure adequate resource provision.
Department of Orthopaedic and Trauma Surgery, Hairmyres Hospital, East Kilbride, United Kingdom. graemeholt@btinternet.com
G
G
Holt
R
R
Smith
K
K
Duncan
J D
JD
Hutchison
D
D
Reid
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005544:Forecasting / Q000379:methods*; D017048:Health Care Costs / Q000639:trends; D019456:Health Transition; D006620:Hip Fractures / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D006753:Hospital Records / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D013222:State Medicine / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology