title: Death, debility, and destitution following hip fracture.
abstract: BACKGROUND
  We examined the effects of hip fracture on mortality, entry into long-term institutional care, and new evidence of poverty. We estimate of the proportion of hip fracture patients who require not just short-term rehabilitation but who become dependent on long-term institutional care, and the risk of becoming newly dependent on Medicaid or eligible for low-income subsidies following hip fracture.
  
  
  METHODS
  We used data from 2005 through 2010 for a random 5% sample of Medicare beneficiaries (N = 3.1 million) to conduct a retrospective matched cohort study. We used high-dimensional propensity score matching to compare outcomes for patients who experienced a hip fracture with subjects who did not, but had similar propensity for suffering a hip fracture. We then compared the 1-year risk of death, debility, and destitution between groups.
  
  
  RESULTS
  We matched 43,210 hip fracture patients to comparators without a hip fracture. Hip fractures were associated with more than a twofold increase in likelihood of mortality (incidence proportion ratio [IPR] of 2.27, 95% CI, 2.20-2.34), a fourfold increase in likelihood of requiring long-term nursing facility care (IPR, 3.96; 95% CI, 3.77-4.16), and a twofold increase in the probability of entering into low-income status (IPR, 2.14; 95% CI 1.99-2.31) within 1 year following hip fracture compared with subjects without a hip fracture.
  
  
  CONCLUSIONS
  Hip fracture in elderly patients resulted in increased death, debility, and destitution. Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures, subsequent death, debility, and destitution for older adults.
authors.affiliation: MSPH, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, RPHB 330, Birmingham, AL 35294-0022. mkilgore@uab.edu.
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Tajeu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Delzell
authors.forename: Wilson
authors.initials: W
authors.lastname: Smith
authors.forename: Tarun
authors.initials: T
authors.lastname: Arora
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morrisey
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007326:Institutionalization / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012923:Social Class; D014481:United States / Q000453:epidemiology
keywords: High-dimensional propensity score; Hip fracture; Mortality; Osteoporosis.