The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location and ethnicity

Abstract

Summary: One-year mortality following a fracture was greater for men compared to women, varied markedly between regions in England with the lowest rates in the London region, and was higher among black women compared to white women. The excess in mortality did not change during the study period.

Introduction: Fractures are associated with increased mortality. With the shift towards an increasingly elderly demography, and so increasing numbers of fractures, the impact of such events on mortality is of key public health importance. Therefore, we aimed to present up to date mortality rates following fracture in England.

Methods: This was a population-based study within the Clinical Practice Research Datalink, linked to death certificates (1 January 2001 and 31 December 2011). Subjects were followed from their first fracture (hip, wrist, humerus, clinical spine, ribs or pelvis) until death for up to one year. Rate ratios (RRs) were estimated for one-year mortality, stratified by sex, 5-year age categories, ethnicity, and geographical region. Excess mortality was presented as Standardized Mortality Ratios (SMRs).

Results: One-year mortality following fracture increased with age and was higher for men. Black women (RR 1.77; 95% CI: 1.00-3.12) and women with other ethnicities (RR 1.59, 95% CI: 1.16-2.16) were at higher risk of death when compared to white women. Mortality was higher among women in almost all regions when compared to the London region, with the highest risk in the East Midlands (37% higher). The one-year mortality risk was more than 3-fold higher after fracture as compared to the general population (adjusted [adj.] SMR: 3.15, 95% CI: 3.09 – 3.26) and did not change during the study period. Major causes of death were neoplasms, respiratory diseases, and circulatory diseases.

Conclusion: This study provides up to date mortality outcomes following fracture in England, and will aid allocation of healthcare provision to those at greatest need.

More information

Identifiers

ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

ORCID for Nicholas Harvey: orcid.org/0000-0002-8194-2512

Catalogue record

Export record