title: Trends in incidence rate, health care consumption, and costs for patients admitted with a humeral fracture in The Netherlands between 1986 and 2012.
abstract: BACKGROUND
  This study aimed to examine long-term population-based trends in the incidence rate of patients with a humeral fracture admitted to a hospital in the Netherlands from 1986 to 2012 and to give a detailed overview of the health care consumption and productivity loss with associated costs.
  
  
  METHODS
  Age and gender-standardised incidence rates of hospital admissions for patients with a proximal, shaft, or distal humeral fracture were calculated for each year (1986-2012). Injury cases, length of hospital stay (LOS), trauma mechanism, and operation rate were extracted from the National Medical Registration. An incidence-based cost model was applied to calculate costs for direct health care and lost productivity in 2012.
  
  
  RESULTS
  Between 1986 and 2012 112,910 patients were admitted for a humeral fracture. The incidence rate increased from 17.8 in 1986 to 40.0 per 100,000 person years in 2012. Incidence rates of proximal fractures increased the most, especially in elderly women. Operation rates decreased in patients aged 70 years or older. The mean LOS decreased from nine days in 1997 to five days in 2012. The cumulative LOS of all patients in 2012 was 28,880 days of which 73% were caused by women and 81% were caused by patients aged 50 years or older. Cumulative medical costs in 2012 were M€55.4, of which M€43.4 was spent on women. Costs increased with age. Costs for hospital care contributed most to the overall costs per case until 70 years of age. From 70 years onwards, the main cost determinants were hospital care, rehabilitation/nursing care, and home care. Cumulative costs due to lost productivity were M€23.5 in 2012. Costs per case increased with age in all anatomic regions.
  
  
  CONCLUSIONS
  The crude number of patients admitted for a humeral fracture increased 124% in 27 years, and was associated with age and gender. Proximal fractures in elderly women accounted most significantly for this increase and most of the costs. The main cost determinants were hospital care and productivity loss.
authors: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Kiran C
authors: KC
authors: Mahabier
authors: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Dennis Den
authors: DD
authors: Hartog
authors: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Joyce
authors: J
authors: Van Veldhuizen
authors: Consumer Safety Institute, Amsterdam, The Netherlands.
authors: Martien J M
authors: MJ
authors: Panneman
authors: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors: Suzanne
authors: S
authors: Polinder
authors: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Michael H J
authors: MH
authors: Verhofstad
authors: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: e.vanlieshout@erasmusmc.nl.
authors: Esther M M
authors: EM
authors: Van Lieshout
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D026741:Physical Therapy Modalities / Q000191:economics; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Distal humerus; Epidemiology; Health care costs; Hospital costs; Humeral fractures; Humeral shaft; Incidence rate; Productivity loss; Proximal humerus; Shoulder fractures