Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study


Autoři: Chenggui Zhang aff001;  Jingnan Feng aff002;  Shengfeng Wang aff002;  Pei Gao aff002;  Lu Xu aff002;  Junxiong Zhu aff001;  Jialin Jia aff001;  Lili Liu aff002;  Guozhen Liu aff003;  Jinxi Wang aff004;  Siyan Zhan aff002;  Chunli Song aff001
Působiště autorů: Department of Orthopedics, Peking University Third Hospital, Beijing, China aff001;  Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China aff002;  Peking University Health Information Technology, Beijing, China aff003;  Beijing Healthcom Data Technology, Beijing, China aff004;  Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China aff005
Vyšlo v časopise: Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med 17(8): e1003180. doi:10.1371/journal.pmed.1003180
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003180

Souhrn

Background

Hip fracture is a public health concern because of its considerable morbidity, excess mortality, great risk of disability, and high societal healthcare costs. China has the largest population of older people in the world and is experiencing rapid population aging and facing great challenges from an increasing number of hip fractures. However, few studies reported the epidemiology, especially at a national level. We aimed to evaluate trends in hip fracture incidence and associated costs for hospitalization in China.

Methods and findings

We conducted a population-based study using data between 2012 and 2016 from the national databases of Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance in China, covering about 480 million residents. Data from around 102.56 million participants aged 55 years and older during the study period were analyzed. A total of 190,560 incident hip fracture patients (mean age 77.05 years, standard deviation 8.94; 63.99% female) were identified. Primary outcomes included the age- and sex-specific incidences of hip fracture. Associated annual costs for hospitalization were also calculated. Incidence was described as per 100,000 person-years at risk, and 95% confidence intervals were computed assuming a Poisson distribution. Hip fracture incidence overall in China did not increase during the study period despite rapid population aging. Incidence per 100,000 was 180.72 (95% CI 137.16, 224.28; P < 0.001) in 2012 and 177.13 (95% CI 139.93, 214.33; P < 0.001) in 2016 for females, and 121.86 (95% CI 97.30, 146.42; P < 0.001) in 2012 and 99.15 (95% CI 81.31, 116.99; P < 0.001) in 2016 for males. For both sexes, declines in hip fracture incidence were observed in patients aged 65 years and older, although incidence was relatively stable in younger patients. However, the total absolute number of hip fractures in those 55 years and older increased about 4-fold. The total costs for hospitalization showed a steep rise from US$60 million to US$380 million over the study period. Costs for hospitalization per patient increased about 1.59-fold, from US$4,300 in 2012 to US$6,840 in 2016. The main limitation of the study was the unavailability of data on imaging information to adjudicate cases of hip fracture.

Conclusions

Our results show that hip fracture incidence among patients aged 55 and over in China reached a plateau between 2012 and 2016. However, the absolute number of hip fractures and associated medical costs for hospitalization increased rapidly because of population aging.

Klíčová slova:

Aging – Epidemiology – Health insurance – Hip – China – Chinese people – Medical risk factors – Osteoporosis


Zdroje

1. Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10(6):338–51. doi: 10.1038/nrendo.2014.51 24751883

2. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513–21. doi: 10.1001/jama.2009.50 19190316

3. Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int. 2007;18(6):721–32. doi: 10.1007/s00198-006-0300-1 17216129

4. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture—a systematic review. World J Orthop. 2019;10(3):166–75. doi: 10.5312/wjo.v10.i3.166 30918799

5. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet. 1999;353(9155):802–5. doi: 10.1016/S0140-6736(98)04235-4 10459962

6. Sobolev B, Sheehan KJ, Kuramoto L, Guy P. Risk of second hip fracture persists for years after initial trauma. Bone. 2015;75:72–6. doi: 10.1016/j.bone.2015.02.003 25681701

7. Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, et al. Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int. 2016;27(2):549–58. doi: 10.1007/s00198-015-3277-9 26286626

8. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573–9. doi: 10.1001/jama.2009.1462 19826027

9. Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, et al. Trends in hip fracture rates in Canada. JAMA. 2009;302(8):883–9. doi: 10.1001/jama.2009.1231 19706862

10. Kannus P, Niemi S, Parkkari J, Sievanen H. Continuously declining incidence of hip fracture in Finland: analysis of nationwide database in 1970–2016. Arch Gerontol Geriatr. 2018;77:64–7. doi: 10.1016/j.archger.2018.04.008 29684740

11. Briot K, Maravic M, Roux C. Changes in number and incidence of hip fractures over 12 years in France. Bone. 2015;81:131–7. doi: 10.1016/j.bone.2015.07.009 26164476

12. Holloway KL, Sajjad MA, Mohebbi M, Kotowicz MA, Livingston PM, Khasraw M, et al. The epidemiology of hip fractures across western Victoria, Australia. Bone. 2018;108:1–9. doi: 10.1016/j.bone.2017.12.007 29229437

13. Karampampa K, Ahlbom A, Michaelsson K, Andersson T, Drefahl S, Modig K. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival—a nationwide study of the Swedish population 60 years and older. Bone. 2015;78:55–61. doi: 10.1016/j.bone.2015.04.032 25933944

14. Paruk F, Matthews G, Cassim B. Osteoporotic hip fractures in Black South Africans: a regional study. Arch Osteoporos. 2017;12(1):107–12. doi: 10.1007/s11657-017-0409-1 29209855

15. Azizieh FY. Incidence of hip fracture in Kuwait: a national registry-based study. Arch Osteoporos. 2015;10:40–6. doi: 10.1007/s11657-015-0248-x 26577246

16. Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, et al. Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res. 2012;27(1):125–9. doi: 10.1002/jbmr.519 21956596

17. Ballane G, Cauley JA, Luckey MM, Fuleihan Gel H. Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res. 2014;29(8):1745–55. doi: 10.1002/jbmr.2218 24644018

18. United Nations Population Division. World population prospects 2019: highlights. New York: United Nations Department of Economic and Social Affairs; 2019.

19. Yang Y, Du F, Ye W, Chen Y, Li J, Zhang J, et al. Inpatient cost of treating osteoporotic fractures in mainland China: a descriptive analysis. Clinicoecon Outcomes Res. 2015;7:205–12. doi: 10.2147/CEOR.S77175 25926747

20. Qu B, Ma Y, Yan M, Wu HH, Fan L, Liao DF, et al. The economic burden of fracture patients with osteoporosis in western China. Osteoporos Int. 2014;25(7):1853–60. doi: 10.1007/s00198-014-2699-0 24691649

21. Wang Y, Cui H, Zhang D, Zhang P. Hospitalisation cost analysis on hip fracture in China: a multicentre study among 73 tertiary hospitals. BMJ Open. 2018;8(4):e019147–54. doi: 10.1136/bmjopen-2017-019147 29703850

22. Tian FM, Sun XX, Liu JY, Liu ZK, Liang CY, Zhang L. Unparallel gender-specific changes in the incidence of hip fractures in Tangshan, China. Arch Osteoporos. 2017;12(1):18–24. doi: 10.1007/s11657-017-0313-8 28190173

23. Yan L, Zhou B, Prentice A, Wang X, Golden MH. Epidemiological study of hip fracture in Shenyang, People’s Republic of China. Bone. 1999;24(2):151–5. doi: 10.1016/s8756-3282(98)00168-9 9951786

24. Tian Y, Liu H, Si Y, Cao Y, Song J, Li M, et al. Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: a national time-series study. PLoS Med. 2019;16(1):e1002738. doi: 10.1371/journal.pmed.1002738 30689640

25. Bergstrom U, Bjornstig U, Stenlund H, Jonsson H, Svensson O. Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umea, Sweden. Osteoporos Int. 2008;19(9):1267–73. doi: 10.1007/s00198-007-0549-z 18214568

26. Ambrose AF, Cruz L, Paul G. Falls and fractures: a systematic approach to screening and prevention. Maturitas. 2015;82(1):85–93. doi: 10.1016/j.maturitas.2015.06.035 26255681

27. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–81. doi: 10.1007/s00198-014-2794-2 25182228

28. Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int. 2008;19(1):79–86. doi: 10.1007/s00198-007-0426-9 17641811

29. Glinkowski W, Narloch J, Krasuski K, Sliwczynski A. The increase of osteoporotic hip fractures and associated one-year mortality in Poland: 2008–2015. J Clin Med. 2019;8(9):1487–505.

30. Karayiannis PN, McAlinden MG. Falling age-related incidence of hip fractures in women, but not men, in Northern Ireland: 2001–2011. Osteoporos Int. 2016;27(11):3377–81. doi: 10.1007/s00198-016-3677-5 27344643

31. Ha YC, Kim TY, Lee A, Lee YK, Kim HY, Kim JH, et al. Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int. 2016;27(8):2603–9. doi: 10.1007/s00198-016-3576-9 27112763

32. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15(4):721–39. doi: 10.1359/jbmr.2000.15.4.721 10780864

33. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67(11):974–8. doi: 10.1136/jech-2013-203104 23963506

34. Melton LJ 3rd. Epidemiology of hip fractures: implications of the exponential increase with age. Bone. 1996;18(3 Suppl):121s–5s. doi: 10.1016/8756-3282(95)00492-0 8777076

35. Chen IJ, Chiang CY, Li YH, Chang CH, Hu CC, Chen DW, et al. Nationwide cohort study of hip fractures: time trends in the incidence rates and projections up to 2035. Osteoporos Int. 2015;26(2):681–8. doi: 10.1007/s00198-014-2930-z 25354653

36. Chau PH, Wong M, Lee A, Ling M, Woo J. Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001–09. Age Ageing. 2013;42(2):229–33. doi: 10.1093/ageing/afs177 23204430

37. Yong EL, Ganesan G, Kramer MS, Logan S, Lau TC, Cauley JA, et al. Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium. Osteoporos Int. 2019;30(4):879–86. doi: 10.1007/s00198-019-04839-5 30671610

38. Koh LK, Saw SM, Lee JJ, Leong KH, Lee J. Hip fracture incidence rates in Singapore 1991–1998. Osteoporos Int. 2001;12(4):311–8. doi: 10.1007/s001980170121 11420781

39. Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2011;6:59–155. doi: 10.1007/s11657-011-0060-1 22886101

40. Ministry of Health of the People’s Republic of China. [Key points on the prevention and treatment of osteoporosis.] Capital J Public Health. 2011;5(4):146.

41. Chinese Society of Osteoporosis and Bone Mineral Research. [Guidelines for the diagnosis and treatment of primary osteoporosis (2011).] Chin J Osteoporo Bone Miner Res. 2011;4:2–17.

42. Yu F, Xia W. The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos. 2019;14(1):32–51. doi: 10.1007/s11657-018-0549-y 30848398

43. Lu J, Ren Z, Liu X, Xu YJ, Liu Q. Osteoporotic fracture guidelines and medical education related to the clinical practices: a nationwide survey in China. Orthop Surg. 2019;11(4):569–77. doi: 10.1111/os.12476 31322836

44. Chen FP, Shyu YC, Fu TS, Sun CC, Chao AS, Tsai TL, et al. Secular trends in incidence and recurrence rates of hip fracture: a nationwide population-based study. Osteoporos Int. 2017;28(3):811–8. doi: 10.1007/s00198-016-3820-3 27832325

45. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356(18):1809–22. doi: 10.1056/NEJMoa067312 17476007

46. Degli Esposti L, Girardi A, Saragoni S, Sella S, Andretta M, Rossini M, et al. Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk. Endocrine. 2019;64(2):367–77. doi: 10.1007/s12020-018-1824-9 30515678

47. Crilly RG, Kloseck M, Chesworth B, Mequanint S, Sadowski E, Gilliland J. Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces. Osteoporos Int. 2014;25(1):205–10. doi: 10.1007/s00198-013-2453-z 23907572

48. Zhang CL, Lv C, Liu D. [Analysis of bisphosphonate use in 33 hospitals in Wuhan from 2008 to 2010.] Chin J Drug Application Monitoring. 2011;8(6):372–4.

49. Qian SS, Qin LR, Dai HZ. [Analysis of bisphosphonate use in 34 hospitals in Nanjing from 2010 to 2012.] China Pharmacy. 2014;25(22):2029–31.

50. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991;324(19):1326–31. doi: 10.1056/NEJM199105093241905 2017229

51. Peng YA. [Guidelines on technical interventions for fall prevention in older people.] Chin Pract J Rural Doctor. 2012;19(8):1–13.

52. Ermei J, Jinmei D. Fall prevention education reduces the falling rate on the osteoporosis patients treated with zoledronic acid. Case Rep Clin Med. 2019;8:222–30.

53. Zhang LL, Dalal K, Yin MM, Yuan DG, Andrews JY, Wang SM. The KAP evaluation of intervention on fall-induced injuries among elders in a safe community in Shanghai, China. PLoS ONE. 2012;7(3):e32848. doi: 10.1371/journal.pone.0032848 22479343

54. Korhonen N, Niemi S, Parkkari J, Sievanen H, Palvanen M, Kannus P. Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010. Osteoporos Int. 2013;24(5):1599–603. doi: 10.1007/s00198-012-2190-8 23108781

55. Brown CA, Starr AZ, Nunley JA. Analysis of past secular trends of hip fractures and predicted number in the future 2010–2050. J Orthop Trauma. 2012;26(2):117–22. doi: 10.1097/BOT.0b013e318219c61a 21904226

56. Leung KS, Ngai WK, Tian W. Orthopaedic training in China: experiences from the promotion of orthopaedic specialist training in China. J Bone Joint Surg Br. 2011;93(9):1165–8. doi: 10.1302/0301-620X.93B9.27101 21911525


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