Kwuio 2010-3-29 11:22
年長者發生髖骨骨折之後 死亡率持續增加達5-8倍
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
March 15, 2010 — 根據發表於3月15日內科醫學誌(Annals of Internal Medicine)的統合分析結果，年長者發生髖骨骨折之後，各種原因的死亡率持續增加達5-8倍。
Ziekenhuis Brussel大學的Patrick Haentjens博士等人寫道，雖然已知髖骨骨折之後死亡風險會增加，但不清楚這個增加的死亡率是否會持續，我們總結了有關年長男性和女性髖骨骨折之後的死亡率增加程度與期間的縱向證據。
研究目標是評估年長者發生髖骨骨折之後增加的死亡率，以電子化搜尋MEDLINE和EMBASE在1957至2009年5月間的英文和非英文文章，並以人工方式搜尋納入之文章的參考文獻，由2位獨立回顧者選擇前瞻世代研究。
納入準則為50歲以上女性(22個世代)或男性(17個世代)髖骨骨折的死亡率，此外，納入的研究必須呈現生命表分析，以及髖骨骨折組和年齡性別配對對照組的存活曲線，2位回顧者獨立摘錄存活曲線資料以及有關研究之有效性和一般性的資訊。
髖骨骨折之後的最初3個月內，根據時間對事件之統合分析，各種原因死亡率的相對風險，女性為5.75 (95%信心區間[CI]為 4.94 - 6.67)、男性為7.95 (95% CI，6.13 - 10.30)，雖然相對風險隨著時間明顯降低，但是並未降低到年齡性別配對對照組的比率。
研究者使用生命表這種方法，估計因為髖骨骨折而增加的年度死亡率，相較於沒有骨折的同齡女性，80歲時發生髖骨骨折的白人女性，受傷後第1、2、5和10年時，增加的年度死亡率分別是8%、11%、18%和22%。至於80歲的男性，因為髖骨骨折而增加的年度死亡率，在受傷後第1、2、5和10年時分別是18%、22%、26%和20%。
研究作者寫道，不論男性女性，年長者在髖骨骨折後的最初3個月，各種原因的死亡率風險增加5-8倍，增加的年度死亡率隨著時間而持續，而在任一年紀，男性髖骨骨折之後增加的年度死亡率均高於女性。
此次統合分析的限制包括，可能有出版偏見、各世代研究的樣本大小、觀察期間、選擇的對照組、死因之確認、共病症之校正等皆不同，研究結果僅適合美國白人族群，此分析也無法確認持續增加之風險的原因。
研究作者結論表示，髖骨骨折病患之死亡絕對風險以及增加的各種原因死亡率大多與年紀有關，這些研究發現或許有助於髖骨骨折預防策略的成本效益分析，也可有助於設計髖骨骨折病患的治療策略。
Leuven大學、科學研究資金；國家健康研究中心；Paul B. Beeson獎；以及Willy Gepts基金會、Ziekenhuis Brussel大學等支持本研究。
Mortality Rate in Older Adults Persistently Increased 5- to 8-Fold After Hip Fracture
By Laurie Barclay, MD
Medscape Medical News
March 15, 2010 — All-cause mortality rate in older adults is increased 5- to 8-fold 3 months after hip fracture and persists with time, according to the results of a meta-analysis reported in the March 15 issue of the Annals of Internal Medicine.
"Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear," write Patrick Haentjens, MD, PhD, from the Universitair Ziekenhuis Brussel in Jette, and colleagues. "We summarize longitudinal evidence about the magnitude and duration of excess mortality after hip fracture in older men and women."
The goal of this study was to assess excess mortality rate after hip fracture in older adults. An electronic search of MEDLINE and EMBASE for English-language and non–English-language articles from 1957 to May 2009 and a manual search of bibliographies from identified articles allowed 2 independent reviewers to select prospective cohort studies.
Inclusion criteria were determination of mortality rate in women (22 cohorts) or in men (17 cohorts) 50 years or older with hip fracture. In addition, the included studies had to display a life-table analysis and survival curves of the hip fracture group and age- and sex-matched control groups. Two reviewers independently extracted survival curve data and information regarding study validity and generalizability.
In the first 3 months after hip fracture, relative hazard for all-cause mortality was 5.75 (95% confidence interval [CI], 4.94 - 6.67) in women and 7.95 (95% CI, 6.13 - 10.30) in men, based on time-to-event meta-analyses. Although relative hazards declined markedly with time, they did not return to rates seen in the age- and sex-matched control groups.
Using life-table methods, the investigators estimated excess annual mortality rate attributable to hip fracture. At 1, 2, 5, and 10 years after injury, white women having a hip fracture at age 80 years had excess annual mortality rates of 8%, 11%, 18%, and 22%, respectively, compared with white women of the same age without a fracture. For men aged 80 years, excess annual mortality rates attributable to hip fracture was estimated to be 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively.
"Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture," the study authors write. "Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women."
Limitations of this meta-analysis included possible publication bias, as well as variation among cohort studies in sample size, duration of observation, selection of control groups, ascertainment of death, and adjustment for comorbid conditions. Results were modeled for a white US population, and the analysis could not determine the cause(s) for persistent excess risk.
"The absolute risk for death and the excess all-cause mortality in patients with hip fracture are largely dependent on age," the study authors conclude. "These findings may be helpful when performing cost-effectiveness analyses of hip fracture prevention strategies or designing treatment strategies in patients with hip fracture."
The Fund for Scientific Research, Leuven University; National Institutes of Health; the Paul B. Beeson Award; and the Willy Gepts Foundation, Universitair Ziekenhuis Brussel, supported this study.
Ann Intern Med. 2010;52:380-390.