title: Monitoring progress in the management of hip fractures in South Australia, Australia.
abstract: The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture. Hip fracture admissions increased over the study period. Men fared worst in terms of higher absolute mortality. Refracture rates and male health outcomes require further attention.
  
  
  OBJECTIVE
  The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture in South Australia (SA).
  
  
  METHODS
  Analysis of routinely collected, linked hospital separations data, of patients admitted to public and private hospitals in SA with a principal diagnosis of femoral neck fracture between July 2002 and June 2008 was done. Main outcome measures include number and rates of hospital admissions, 30-day in-hospital and 1-year mortality following a first hip fracture and subsequent event rates, by age and sex.
  
  
  RESULTS
  Unadjusted hip fracture admissions increased in SA from 2002 to 2008 by 20 %, age-standardised (adjusted) admission rates increased overall (+5 %, p = 0.215) and significantly amongst males (+26 %, p = 0.001), while there was no change among women (−1 %, p = 0.763). Within 1 year of a hip fracture, 7 % had broken another bone (5 % had refractured a hip). At 1 year post-fracture, unadjusted mortality was consistently and considerably higher amongst men compared to women (33 versus 19 %, p < 0.001). Age-standardised mortality from admission to 1 year fell but not statistically significantly by 15 % in women (p = 0.131) and 8 % in men (p = 0.510). Women had a reduction in age-standardised in-hospital mortality over time (p = 0.048); there was a non-significant decline in men (p = 0.080).
  
  
  CONCLUSIONS
  Hip fracture admissions in SA increased over the study period and this appears to be driven by an increase in admissions amongst men. Men fared worst in terms of higher absolute mortality. There is some evidence to suggest refracture rates and male health outcomes require further attention.
authors.affiliation: Discipline of Public Health, University of Adelaide, Adelaide, SA 5005, Australia. jason.gordon@adelaide.edu.au
authors.forename: Jason
authors.initials: J
authors.lastname: Gordon
authors.forename: Clarabelle T
authors.initials: CT
authors.lastname: Pham
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000628:therapy; D006620:Hip Fractures / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012307:Risk Factors; D017678:Sex Distribution; D013021:South Australia / Q000453:epidemiology