title: Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.
abstract: BACKGROUND
  In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries.
  
  
  METHODS
  We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable.
  
  
  RESULTS
  Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily.
  
  
  CONCLUSIONS
  Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.
authors.affiliation: Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain. Electronic address: eva.cirera@uvic.cat.
authors.forename: Eva
authors.initials: E
authors.lastname: Cirera
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
authors.forename: Katherine
authors.initials: K
authors.lastname: Pérez
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Santamariña-Rubio
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Novoa
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Olabarria
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006306:Health Surveys; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011159:Population Surveillance; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control
keywords: Fractures; Hip fracture; Injury incidence; Lower extremity fractures; Older people; Population based data; Thoracic injuries; Traumatic brain injuries; Trends; Upper extremity fractures