Trends in Hip Fracture Incidence, Recurrence, and Survival by Education and Comorbidity: A Swedish Register-based Study

Anna C Meyer, Stina Ek, Sven Drefahl, Anders Ahlbom, Margareta Hedström, Karin Modig, Anna C Meyer, Stina Ek, Sven Drefahl, Anders Ahlbom, Margareta Hedström, Karin Modig

Abstract

Background: Hip fractures are common and severe conditions among older individuals, associated with high mortality, and the Nordic countries have the highest incidence rates globally. With this study, we aim to present a comprehensive picture of trends in hip fracture incidence and survival in the older Swedish population stratified by education, birth country, and comorbidity level.

Methods: This study is based on a linkage of several population registers and included the entire population over the age of 60 living in Sweden. We calculated age-standardized incidence rates for first and recurrent hip fractures as well as age-standardized proportions of patients surviving 30 and 365 days through the time period 1998 to 2017. We calculated all outcomes for men and women in the total population and in each population stratum.

Results: Altogether, we observed 289,603 first hip fractures during the study period. Age-standardized incidence rates of first and recurrent fractures declined among men and women in the total population and in each educational-, birth country-, and comorbidity group. Declines in incidence were more pronounced for recurrent than for first fractures. Approximately 20% of women and 30% of men died within 1 year of their first hip fracture. Overall, survival proportions remained constant throughout the study period but improved when taking into account comorbidity level.

Conclusions: Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.

Conflict of interest statement

The authors report no conflicts of interest.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1.
FIGURE 1.
Age-standardized incidence rates of first hip fractures (rates per 1000 person–years) by comorbidity level, educational level, and birth country among men and women 1998–2017. Incidence by educational level includes individuals up to age 90 only. CCI, Charlson Comorbidity Index score.
FIGURE 2.
FIGURE 2.
Age-standardized incidence rates of recurrent hip fractures (rates per 1,000 person–years) by comorbidity level, educational level, and birth country among men and women 1998–2017. Incidence by educational level includes individuals up to age 90 only. CCI, Charlson Comorbidity Index score.
FIGURE 3.
FIGURE 3.
Age-standardized proportion of patients with first hip fracture surviving 30 days by comorbidity level, educational level, and birth country among men and women 1998–2017. Survival by educational level and birth country includes individuals up to age 90 only. CCI, Charlson Comorbidity Index score.
FIGURE 4.
FIGURE 4.
Age-standardized proportion of patients with first hip fracture surviving 365 days by comorbidity level, educational level, and birth country among men and women 1998–2017. Survival by educational level and birth country includes individuals up to age 90 only. CCI, Charlson Comorbidity Index score.

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