Adjusted Mortality After Hip Fracture: From the Cardiovascular Health Study

Abstract

OBJECTIVES: To estimate the risk of death associated with hip fracture (HFx), stratifying by sex and time since fracture. DESIGN: Prospective cohort study compared participants with and without hip fracture, matched on sex, age, race, recruitment period, and time since enrollment. SETTING: The Cardiovascular Health Study, a more‐than‐15‐year longitudinal study of 5,888 older individuals from four U.S. sites. PARTICIPANTS: Three hundred seventy‐nine individuals with HFx were compared with 1,134 without HFx. MEASUREMENTS: Extended Cox models were used to estimate mortality hazard ratios (HRs) for different periods after fracture, adjusting for prefracture health. RESULTS: Age‐ and race‐adjusted excess mortality was 9% in women and 24% in men 1 year after fracture, and 24% in women and 26% men 5 years postfracture. Multivariable‐adjusted HRs of mortality associated with HFx in women were 7.1 (95% confidence interval (CI)=2.3–21.5), 2.1 (95% CI=1.0–4.1), 1.4 (95% CI=1.1–2.0), and 1.0 (95% CI=0.6–1.5) for 0 to 1 months, 2 to 6 months, 7 months to 4 years, and 5 to 8 years, respectively, after index date. In men, respective HRs for the same time periods were 39.9 (95% CI=5.2–308.7), 3.8 (95% CI=1.4–10.3), 1.1 (95% CI=0.7–1.8), and 1.0 (95% CI=0.3–2.7). HRs adjusted for age and race were 20% to 40% higher. CONCLUSION: The risk of mortality was highest in the first 6 months after HFx. In men, the risk of death approximated that of men without HFx after 6 months; in women, a moderately greater risk persisted through the fourth year. Although the mortality pattern was different in women and men, excess mortality 5 years postfracture was similar for both sexes.