(144) Hip fracture incidence and post-fracture mortality in Victoria, Australia from 2012 to 2018

Publication Number: 805

Background: Hip fractures are a major public health concern in Australia. Data on hip fracture incidence and mortality are needed to plan and evaluate healthcare interventions.

Objectives: To investigate the time-trend in absolute number and incidence of first hip fractures, and the factors associated with mortality following first hip fractures in Victoria, Australia, between 2012 to 2018

Methods: We conducted a population-based cohort study of all patients aged ≥30 years admitted to a Victorian public or private hospital for first hip fracture between July 2012 and June 2018. Annual age-standardized incidence rates were calculated. Multivariate negative binomial regression was used to compute the age- and sex-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for trends in incidence and mortality. Factors associated with 30-day and one-year all-cause mortality were estimated using the same model.

Results: Overall, 32,395 patients were admitted for hip fractures, 68% were female, 46% were ≥85 years old. 26% patients had multimorbidity (Charlson Comorbidity Index ≥3) and 28% had intermediation to high pre-admission frailty risk (Hospital Frailty Risk Scores [HFRS] ≥5). Absolute annual numbers of first hip fractures increased by 20% from 2012-13 to 2017-18. There was no significant change in age- and sex-adjusted incidence or mortality. Factors associated with 30-day mortality included age (≥85 years old versus 30-64 years old, IRR 9.37, 95% CI 6.98-12.84), male sex (IRR 2.10, 95% CI 1.87-2.35), higher HFRS (high frailty versus no frailty, IRR 3.43, 95% CI 2.63-4.45), admission from a residential aged care facility (RACF) (IRR 2.27, 95% CI 1.85-2.80), and residing in non-metropolitan region (IRR 1.23, 95% CI 1.10-1.39). The same factors were associated with one-year mortality.

Conclusions: The absolute increase in hip fractures highlights the need for further interventions to reduce fracture risk. Interventions should target those at highest risk of mortality, including males and those who are frail, living in non-metropolitan region or resident in a RACF.