OR10-3 Morbidity and Mortality following Proximal Hip Fracture in Older Women

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR10-Osteoporosis
Clinical
Saturday, June 15, 2013: 11:30 AM-1:00 PM
Presentation Start Time: 12:00 PM
Room 121 (Moscone Center)
Sowmya Srinivasan*1, Malini Chandra2, Mary Patton1, Amer A Budayr1 and Joan C. Lo2
1Kaiser Permanente Oakland Medical Center, Oakland, CA, 2Kaiser Permanente Northern California, Oakland, CA
Introduction: Hip fractures are associated with significant morbidity and mortality in postmenopausal women. This study examines contemporary rates of re-hospitalization and mortality following proximal hip fracture in older women within an integrated healthcare delivery system.

 Methods: Hospitalization records were used to identify women age ≥65 years in Kaiser Permanente Northern California who experienced a proximal hip fracture during 2000-2008.  Demographic and clinical characteristics were obtained from health plan databases.  Outcomes included hospital discharge disposition, re-hospitalization within 90 days after discharge, and all-cause mortality at 6 and 12 months after hip fracture.

 Results:  There were 10,650 women with an index hip fracture during 2000-2008. The majority (84.7%) were age ≥75 years and of white race (82.8% white, 2.8% black, 5.4% Hispanic, 3.7% Asian, 5.3% of other/unknown race). During the index hospitalization, 262 (2.5%) died prior to discharge, 8167 (76.7%) were discharged to a skilled nursing facility, and 1913 (18.0%) were discharged to home, with or without home health services. There were 2056 (19.3%) women who were re-hospitalized within 90 days of discharge. Excluding orthopedic indications, pneumonia and cardiovascular disease were the most common reasons for readmission. At 6 months and 1 year, the overall mortality rate was 17.2% and 23.2%, respectively, and increased substantially with age.  The 1 year mortality was 14.1% for women age 65-74, 17.8% for age 75-84 and 32.6% for age ≥85 years old.  One year mortality also varied by race/ethnicity with rates higher among whites compared to Hispanics and Asians, but not different compared to blacks. For age 65-74, Hispanics had a lower mortality than whites and for age ≥85, both Hispanics and Asians had a lower mortality compared to whites. In multivariable logistic regression, older age, white race and higher comorbidity index were associated with greater odds of death within 1 year following hip fracture. 

 Conclusions: Hip fracture mortality rates are high among older postmenopausal women, particularly those of white race, with a 2-fold difference in mortality between those age ≥85 years and age 65-74 years. Women with hip fracture were also at high risk for re-hospitalization within 90 days of discharge, especially for cardiac and pulmonary diagnoses.  Future studies should examine demographic and clinical predictors of increased morbidity following hip fracture.

Nothing to Disclose: SS, MC, MP, AAB, JCL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Kaiser Permanente Community Benefit Grant