title: Excess Mortality After Pelvic Fractures Among Older People.
abstract: The study aimed to estimate excess mortality in patients aged 60 years or older up to 1 year after pelvic fracture compared with a population without pelvic fracture. In this retrospective population-based observational study, we use routine data from a large health insurance in Germany. For each patient with a first pelvic fracture between 2008 and 2010 (n = 5685 cases, 82% female, mean age 80 ± 9 years), about 34 individuals without pelvic fracture (n = 193,159 controls) were frequency matched by sex, age at index date, and index month. We estimated survival probabilities in the first year after the index date separated for cases (further stratified into inpatient/outpatient treated or minor/major pelvic fractures) and controls using Kaplan-Meier curves. Additionally, time-dependent hazard ratios (HRs) measuring excess mortality in 4-week intervals up to 52 weeks were estimated by fitting Cox regression models including adjustment for relevant confounders. Twenty-one percent of cases and 11% of controls died within 1 year. HRs (95% confidence intervals) decreased from 3.9 (3.5-4.5) within the first 4 weeks to 1.4 (1.1-1.9) within weeks 49 to 52 after the index date. After full adjustment, HRs lowered substantially (3.0 [2.6-3.4] and 1.0 [0.8-1.4]) but were still significantly increased up to week 32. Adjusted HRs in women were lower than in men: 2.8 (2.4-3.2) and 1.0 (0.7-1.4) versus 3.8 (2.9-5.0) and 1.2 (0.6-2.3). We found a clear excess mortality among older people in the first 8 months after pelvic fracture even after full adjustment. Excess mortality was higher among men in the beginning as well as for inpatient-treated persons. Absence of excess mortality was noticed for outpatient-treated persons within the first 3 months. When broken down into site-specific data, excess mortality was no longer significant for most pelvic fractures classified as minor. The only exception was fracture of pubis within the first 4 weeks. © 2017 American Society for Bone and Mineral Research.
authors.affiliation: Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Andrich
authors.affiliation: Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.|mediStatistica, Neuenrade, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Haastert
authors.affiliation: AOK NordWest, Dortmund, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Neuhaus
authors.affiliation: AOK NordWest, Dortmund, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Neidert
authors.affiliation: Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Arend
authors.affiliation: Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ohmann
authors.affiliation: Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Grebe
authors.affiliation: Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Vogt
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jungbluth
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Thelen
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.affiliation: Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D018572:Disease-Free Survival; D005260:Female; D050723:Fractures, Bone / Q000401:mortality*; D006801:Humans; D008297:Male; D010384:Pelvic Bones; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: EPIDEMIOLOGY; EXCESS MORTALITY; HEALTH SERVICES RESEARCH; INPATIENT TREATMENT; OUTPATIENT TREATMENT; PELVIC FRACTURE; POPULATION-BASED STUDY