Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Analyzing the Risk Factors of Mortality after Osteoporotic Hip Fractures Using the National Health Insurance Service Sample Cohort 2.0 Database

  • Hoe Jeong Chung (Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Doo Sup Kim (Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Jin Woo Lee (Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Seok In Hong (Internship of Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
  • Received : 2022.02.14
  • Accepted : 2022.05.31
  • Published : 2022.09.30
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Abstract

Purpose: The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database. Materials and Methods: Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models. Results: Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601). Conclusion: Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.

Keywords

References

  1. Lim S, Koo BK, Lee EJ, et al. Incidence of hip fractures in Korea. J Bone Miner Metab. 2008;26:400-5. https://doi.org/10.1007/s00774-007-0835-z 
  2. Choi HJ, Shin CS, Ha YC, et al. Burden of osteoporosis in adults in Korea: a national health insurance database study. J Bone Miner Metab. 2012;30:54-8. Erratum in: J Bone Miner Metab. 2012;30:59. https://doi.org/10.1007/s00774-011-0280-x 
  3. Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009;91:2376-80. https://doi.org/10.2106/JBJS.H.01871 
  4. Choi ES, Shon HC, Kim YM, et al. Is the incidence rate of hip fractures still increasing in Korea?: an epidemiologic study based on national health insurance database. J Korean Orthop Assoc. 2016;51:447-54. https://doi.org/10.4055/jkoa.2016.51.6.447 
  5. Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:24-35. https://doi.org/10.1359/jbmr.1997.12.1.24 
  6. Melton LJ 3rd. Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res. 2003;18:1139-41. https://doi.org/10.1359/jbmr.2003.18.6.1139 
  7. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1:6-14. https://doi.org/10.1177/2151458510378105 
  8. Panula J, Pihlajamaki H, Mattila VM, et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011;12:105. https://doi.org/10.1186/1471-2474-12-105 
  9. Kim SR, Ha YC, Kim JR, Kim R, Kim SY, Koo KH. Incidence of hip fractures in Jeju Island, South Korea: a prospective study (2002-2006). Clin Orthop Surg. 2010;2:64-8. https://doi.org/10.4055/cios.2010.2.2.64 
  10. Statistics Korea. Population projection (2017-2067) [Internet]. Daejeon: Statistics Korea; 2019 Mar 28 [cited 2021 Nov 1]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=373873. 
  11. Park C, Jang S, Jang S, et al. Identification and validation of osteoporotic hip fracture using the National Health Insurance Database. J Korean Hip Soc. 2010;22:305-11. https://doi.org/10.5371/jkhs.2010.22.4.305 
  12. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987;69:1335-40.  https://doi.org/10.2106/00004623-198769090-00005
  13. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ. 1993;307:1248-50. https://doi.org/10.1136/bmj.307.6914.1248 
  14. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma. 1997;11:162-5. https://doi.org/10.1097/00005131-199704000-00004 
  15. Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol. 2003;56:788-95. https://doi.org/10.1016/s0895-4356(03)00129-x 
  16. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374. https://doi.org/10.1136/bmj.38643.663843.55 
  17. von Friesendorff M, Besjakov J, Akesson K. Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res. 2008;23:1832-41. https://doi.org/10.1359/jbmr.080606 
  18. Choi JY, Na HY, Lee YS, Lee WY, Choi JW. Mortality after treatment of hip fracture over 80 years old. J Korean Hip Soc. 2006;18:116-20. https://doi.org/10.5371/jkhs.2006.18.3.116 
  19. Kim DS, Shon HC, Kim YM, Choi ES, Park KJ, Im SH. Postoperative mortality and the associated factors for senile hip fracture patients. J Korean Orthop Assoc. 2008;43:488-94. https://doi.org/10.4055/jkoa.2008.43.4.488 
  20. Chang JD, Yoo JH, Lee SS, Kim TY, Jung KH, Kim YK. Bipolar hemiarthroplasty for hip fractures in patients aged over 90 years- the factors influencing the postoperative mortality -. J Korean Hip Soc. 2010;22:283-90. https://doi.org/10.5371/jkhs.2010.22.4.283 
  21. Sullivan KJ, Husak LE, Altebarmakian M, Brox WT. Demographic factors in hip fracture incidence and mortality rates in California, 2000-2011. J Orthop Surg Res. 2016;11:4. https://doi.org/10.1186/s13018-015-0332-3 
  22. Ha YC, Park YG, Nam KW, Kim SR. Trend in hip fracture incidence and mortality in Korea: a prospective cohort study from 2002 to 2011. J Korean Med Sci. 2015;30:483-8. https://doi.org/10.3346/jkms.2015.30.4.483 
  23. Lee SA, Choi KS, Hwang SY, Lee JY, Park EC, Lee KJ, et al. The effect of socioeconomic factors on health screening on Korea: the 2001 Korean National Examination Health and Nutrition Surveys (KNEHANS). J Korean Assoc Cancer Prev. 2004;9:188-98. https://kmbase.medric.or.kr/Fulltext/06035/2004-9-3/188-198.pdf 
  24. Hoebel J, Starker A, Jordan S, Richter M, Lampert T. Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study. BMC Public Health. 2014;14:913. https://doi.org/10.1186/1471-2458-14-913 
  25. Meyer HE, Tverdal A, Falch JA. Body height, body mass index, and fatal hip fractures: 16 years' follow-up of 674,000 Norwegian women and men. Epidemiology. 1995;6:299-305. https://www.jstor.org/stable/3702396  https://doi.org/10.1097/00001648-199505000-00019
  26. Akinleye SD, Garofolo G, Culbertson MD, Homel P, Erez O. The role of BMI in hip fracture surgery. Geriatr Orthop Surg Rehabil. 2018;9:2151458517747414. https://doi.org/10.1177/2151458517747414 
  27. Prieto-Alhambra D, Premaor MO, Aviles FF, et al. Relationship between mortality and BMI after fracture: a population-based study of men and women aged ≥40 years. J Bone Miner Res. 2014;29:1737-44. https://doi.org/10.1002/jbmr.2209 
  28. Kim YK, Yi SR, Lee YH, Kwon J, Jang SI, Park SH. Effect of sarcopenia on postoperative mortality in osteoporotic hip fracture patients. J Bone Metab. 2018;25:227-33. https://doi.org/10.11005/jbm.2018.25.4.227 
  29. Yoo JI, Kim H, Ha YC, Kwon HB, Koo KH. Osteosarcopenia in patients with hip fracture is related with high mortality. J Korean Med Sci. 2018;33:e27. https://doi.org/10.3346/jkms.2018.33.e27 
  30. Peterson MG, Cornell CN, Paget SA, Allegrante JP. Five-year survival in a cohort of hip fracture patients: the predictive role of pre-fracture health status. HSS J. 2008;4:43-7. https://doi.org/10.1007/s11420-007-9074-z 
  31. Seitz DP, Anderson GM, Austin PC, et al. Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases. BMC Geriatr. 2014;14:9. https://doi.org/10.1186/1471-2318-14-9 
  32. Forni C, Gazineo D, D'Alessandro F, et al. Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. Int Orthop. 2019;43:275-81. https://doi.org/10.1007/s00264-018-4057-x 
  33. Solbakken SM, Meyer HE, Stigum H, et al. Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study. Osteoporos Int. 2017;28:881-7. https://doi.org/10.1007/s00198-016-3795-0 
  34. Vosoughi AR, Emami MJ, Pourabbas B, Mahdaviazad H. Factors increasing mortality of the elderly following hip fracture surgery: role of body mass index, age, and smoking. Musculoskelet Surg. 2017;101:25-9. https://doi.org/10.1007/s12306-016-0432-1 
  35. Kim DW, Lee SM, Lim HS, et al. A study on the operational definition of disease based on national health insurance claim data. Goyang: NHIS Ilsan Hospital Institute Health Insurance & Clinical Research; 2017 Dec. Report No.: 2017-20-029. 
  36. Tolppanen AM, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S. Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer's disease- exposure-matched cohort study. BMC Geriatr. 2016;16:204. https://doi.org/10.1186/s12877-016-0383-2 
  37. Ahn SH, Park SM, Park SY, et al. Osteoporosis and osteoporotic fracture fact sheet in Korea. J Bone Metab. 2020;27:281-90. https://doi.org/10.11005/jbm.2020.27.4.281