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

The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location and ethnicity
The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location and ethnicity
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.
0937-941X
1-25
Klop, Corinne
476d082c-d82a-45de-9ed6-c6840e1ebc10
van Staa, Tjeerd
76db275d-12ed-44e8-8dd1-2d70e945fc07
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
de Vries, Frank
c6020528-4ac1-4d59-8ab1-8a20c7a6ffda
Klop, Corinne
476d082c-d82a-45de-9ed6-c6840e1ebc10
van Staa, Tjeerd
76db275d-12ed-44e8-8dd1-2d70e945fc07
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
de Vries, Frank
c6020528-4ac1-4d59-8ab1-8a20c7a6ffda

Klop, Corinne, van Staa, Tjeerd, Cooper, Cyrus, Harvey, Nicholas and de Vries, Frank (2016) The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location and ethnicity. Osteoporosis International, 1-25. (In Press)

Record type: Article

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.

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Accepted/In Press date: 22 September 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 401094
URI: http://eprints.soton.ac.uk/id/eprint/401094
ISSN: 0937-941X
PURE UUID: 9e8f29d5-9d3a-47d0-8b7b-2014516464a7
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 06 Oct 2016 16:05
Last modified: 07 Oct 2020 04:06

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Contributors

Author: Corinne Klop
Author: Tjeerd van Staa
Author: Cyrus Cooper ORCID iD
Author: Nicholas Harvey ORCID iD
Author: Frank de Vries

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