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.
