Omar Amir1, Sarah D Berry2, Andrew R Zullo3, Douglas P Kiel4, Tingting Zhang5. 1. VA Boston Healthcare System & Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. 2. Hebrew SeniorLife, Institute of Aging Research & Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, 1200 Centre Street, Boston, MA 02131, USA. Electronic address: sarahberry@hsl.harvard.edu. 3. Department of Health Services, Policy and Practice and Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912, USA. Electronic address: andrew_zullo@brown.edu. 4. Institute for Aging Research and Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, 1200 Centre Street, Boston, MA 02131, USA. Electronic address: kiel@hsl.harvard.edu. 5. Department of Health Services, Policy and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912, USA. Electronic address: tingting_zhang@brown.edu.
Abstract
OBJECTIVES: To compare the standardized incidence rates (IRs) of hip fracture for Native Americans versus other racial groups in U.S. nursing homes (NHs). METHODS: We studied Medicare fee-for-service NH residents aged ≥65 years who became long-stay (index date) between 1/1/2008 and 12/31/2009 (n = 1,136,544). Residents were followed from the index date until occurrence of hip fracture, death, Medicare disenrollment, or study end (12/31/2013). We calculated hip fracture IRs by race and used inverse probability weighting to standardize the rates for baseline demographic and clinical characteristics collected from the Minimum Data Set and Medicare claims data. We compared characteristics of NHs used by residents of different races using Online Survey, Certification and Reporting (OSCAR) data. RESULTS: Among long-stay U.S. NH residents, the standardized IR of hip fracture per 100 person-years was highest in Native Americans [2.16; 95% confidence interval (CI) 1.91-2.44] and white residents (2.05; 2.03-2.06), and lowest in black residents (0.82; 0.79-0.85). NHs caring for Native American residents were more likely to be rurally located as compared to other racial group. CONCLUSIONS: In U.S. NHs, Native Americans and whites have the highest standardized IR of hip fracture and should receive particular attention in fracture prevention efforts.
OBJECTIVES: To compare the standardized incidence rates (IRs) of hip fracture for Native Americans versus other racial groups in U.S. nursing homes (NHs). METHODS: We studied Medicare fee-for-service NH residents aged ≥65 years who became long-stay (index date) between 1/1/2008 and 12/31/2009 (n = 1,136,544). Residents were followed from the index date until occurrence of hip fracture, death, Medicare disenrollment, or study end (12/31/2013). We calculated hip fracture IRs by race and used inverse probability weighting to standardize the rates for baseline demographic and clinical characteristics collected from the Minimum Data Set and Medicare claims data. We compared characteristics of NHs used by residents of different races using Online Survey, Certification and Reporting (OSCAR) data. RESULTS: Among long-stay U.S. NH residents, the standardized IR of hip fracture per 100 person-years was highest in Native Americans [2.16; 95% confidence interval (CI) 1.91-2.44] and white residents (2.05; 2.03-2.06), and lowest in black residents (0.82; 0.79-0.85). NHs caring for Native American residents were more likely to be rurally located as compared to other racial group. CONCLUSIONS: In U.S. NHs, Native Americans and whites have the highest standardized IR of hip fracture and should receive particular attention in fracture prevention efforts.
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