TY  - JOUR
AU  - Dimet-Wiley, Andrea
AU  - Golovko, George
AU  - Watowich, Stanley J
PY  - 2022
DA  - 2022/3/16
TI  - One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study
JO  - JMIR Aging
SP  - e32683
VL  - 5
IS  - 1
KW  - hip
KW  - fracture
KW  - mortality
KW  - aging
KW  - older adults
KW  - elderly
KW  - mortality risk
KW  - electronic health record
KW  - EHR
KW  - survival probability
KW  - postfracture mortality rate
KW  - fall
KW  - bone
KW  - injury
KW  - dementia
KW  - diabetes
KW  - type 2 diabetes
KW  - trauma
KW  - treatment
KW  - comorbidity
KW  - mobility
AB  - Background: Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. Objective: This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. Methods: TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. Results: One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. Conclusions: Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2022/1/e32683
UR  - https://doi.org/10.2196/32683
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35293865
DO  - 10.2196/32683
ID  - info:doi/10.2196/32683
ER  -