title: Direct costs of osteoporosis-related hip fractures: protocol for a cross-sectional analysis of a national database.
abstract: It is estimated that Iran accounted for about 1% of hip fracture burden of the world in 2007, but these data are based on incomplete evidence. As the country's population is ageing, it is expected that a dramatic rise in hip fracture incidence will result. There is no single national study that accurately estimates the incidence of all hip fractures in the country or identifies the direct costs for affected patients. To help fill this gap, the current study has been designed to determine the incidence of hip fracture associated with osteoporosis in the Iranian population and to assess the direct costs involved.
  
  
  
  This is a cross-sectional analysis of 2 years of hospital admissions due to hip fracture in Iran from October 2014 to October 2016 using an electronic health record called SEPAS. SEPAS is a nationwide health information system established by Information Technology (IT) and the Statistics Department of the Ministry of Health. SEPAS has recorded more than 8.5 million inpatient hospitalizations since October 2014. Our study will identify reported hip fracture data in SEPAS among admitted adult hospital patients aged ≥50 in Iran. International Classification of Diseases ICD-9 and 10 will be used as diagnostic codes. Study factors are demographic data, types of fracture, types of treatment, duration of admission, early complications, in-hospital mortality and direct cost of fracture treatment. The accuracy of the SEPAS fracture data will be ascertained through a pilot study that compares the SEPAS data with the data directly extracted from medical records of the Shariati Hospital in Tehran during the study period.
  
  
  
  The study protocol was approved by the Ethics Committee of the National Institute for Medical Research Development of Iran. Dissemination plans include academic publications, conference presentations and social media.
authors.affiliation: Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zhila
authors.initials: Z
authors.lastname: Maghbooli
authors.affiliation: Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Campus, Boston, Massachusetts, USA arash_hsi@yahoo.com.
authors.forename: Arash
authors.initials: A
authors.lastname: Hossein-Nezhad
authors.affiliation: Statistics and Information Technology, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Jafarpour
authors.affiliation: Statistics and Information Technology, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Sima
authors.initials: S
authors.lastname: Noursaadat
authors.affiliation: Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Ramezani
authors.affiliation: Boston University School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Roxana
authors.initials: R
authors.lastname: Hashemian
authors.affiliation: Department of Health Sciences, Worcester State University, Worcester, Massachusetts, USA.
authors.forename: Syamak
authors.initials: S
authors.lastname: Moattari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004180:Direct Service Costs; D005260:Female; D006620:Hip Fractures / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology
keywords: Direct Costs; Early Complication; Fracture; Health System Research; Hip Fracture; Hospital Information System; In-Hospital Mortality; Medical Information; National Database; Osteoporosis; SEPAS; length of Hospital Stay