title: Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project.
abstract: Hip fractures are associated with diminished quality of life and survival especially amongst the elderly.
  
  
  
  All-cause mortality after hip fracture was investigated to assess its magnitude.
  
  
  
  A total of 122 808 participants from eight cohorts in Europe and the USA were followed up for a mean of 12.6 years, accumulating 4273 incident hip fractures and 27 999 deaths. Incident hip fractures were assessed through telephone interviews/questionnaires or national inpatient/fracture registries, and causes of death were verified with death certificates. Cox proportional hazards models and the time-dependent variable methodology were used to assess the association between hip fracture and mortality and its magnitude at different time intervals after the injury in each cohort. We obtained the effect estimates through a random-effects meta-analysis.
  
  
  
  Hip fracture was positively associated with increased all-cause mortality; the hazard ratio (HR) in the fully adjusted model was 2.12, 95% confidence interval (CI) 1.76-2.57, after adjusting for potential confounders. This association was stronger amongst men [HR: 2.39, 95% CI: 1.72-3.31] than amongst women [HR: 1.92, 95% CI: 1.54-2.39], although this difference was not significant. Mortality was higher during the first year after the hip fracture [HR: 2.78, 95% CI: 2.12-3.64], but it remained elevated without major fluctuations after longer time since hip fracture [HR (95% CI): 1.89 (1.50-2.37) after 1-4 years; 2.15 (1.81-2.55) after 4-8 years; 1.79 (1.57-2.05) after 8 or more years].
  
  
  
  In this large population-based sample of older persons across eight cohorts, hip fracture was associated with excess short- and long-term all-cause mortality in both sexes.
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Katsoulis
authors.affiliation: School of Medicine, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Benetou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Karapetyan
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Feskanich
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Grodstein
authors.affiliation: Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Pettersson-Kymmer
authors.affiliation: Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Eriksson
authors.affiliation: Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: Department of Health and Care Sciences, UIT The Arctic University of Norway, Tromsø, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Jørgensen
authors.affiliation: Department of Health and Care Sciences, UIT The Arctic University of Norway, Tromsø, Norway.|Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
authors.forename: L A
authors.initials: LA
authors.lastname: Ahmed
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schöttker
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bellavia
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wolk
authors.affiliation: National Institute of Public Health, Prague, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Kubinova
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stegeman
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Bobak
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
mesh_terms: D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: CHANCES; ageing; bone; hip fracture; mortality