Mikk Jürisson1, Mait Raag2, Riina Kallikorm3,4, Margus Lember3,4, Anneli Uusküla2. 1. Institute of Family Medicine and Public Health, University of Tartu, Ravila st 19, 50411, Tartu, Estonia. mikkjurisson@gmail.com. 2. Institute of Family Medicine and Public Health, University of Tartu, Ravila st 19, 50411, Tartu, Estonia. 3. Faculty of Medicine, University of Tartu, Ravila st 19, 50411, Tartu, Estonia. 4. Internal Medicine Clinic, Tartu University Hospital, L. Puusepa st 8, 51014, Tartu, Estonia.
Abstract
The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age- and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture. PURPOSE: This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women ≥ 50 years of age. METHODS: Retrospective, population-based 10-year study of people aged ≥ 50 in two cohorts: those with a hip fracture and an age- and sex-matched random sample from the national health insurance fund for comparison. RESULTS: We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups ≥ 3 and 1-2 exceeded that in the CCI 0 group over 5-7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age- and time-dependent: in younger hip fracture patients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest. CONCLUSIONS: The presence of pre-fracture comorbidities increases the risk of excess death in hip fracture patients, but the comorbidity impact on aggregated excess mortality is modest.
The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age- and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture. PURPOSE: This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women ≥ 50 years of age. METHODS: Retrospective, population-based 10-year study of people aged ≥ 50 in two cohorts: those with a hip fracture and an age- and sex-matched random sample from the national health insurance fund for comparison. RESULTS: We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups ≥ 3 and 1-2 exceeded that in the CCI 0 group over 5-7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age- and time-dependent: in younger hip fracturepatients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest. CONCLUSIONS: The presence of pre-fracture comorbidities increases the risk of excess death in hip fracturepatients, but the comorbidity impact on aggregated excess mortality is modest.
Entities:
Keywords:
Charlson comorbidity index; Comorbidities; Hip fracture; Mortality
Authors: Adam Omari; Christian Medom Madsen; Jes Bruun Lauritzen; Henrik Løvendahl Jørgensen; Fie Juhl Vojdeman Journal: Int Orthop Date: 2019-03-23 Impact factor: 3.075