The relationship between chronic obstructive pulmonary disease, comorbidity and mortality following hip fracture.

摘要

Background. Hip fracture is associated with high mortality which has remained relatively unchanged for the last 20 years. Identifying predictors for survival is crucial in order to reduce mortality.;Objective. Using a large population based prospective cohort design, the association between chronic obstructive pulmonary disease (COPD), comorbidity and mortality following hip fracture was examined.;Methods. Among a population-based cohort in Western Denmark (1.4 million inhabitants), all persons ≥ 40 years of age with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003 were identified. Prior hospitalization for COPD, other comorbid conditions, and prescription data were ascertained from the healthcare registries. Five controls from the source population without hip fracture were matched to hip fracture patients on age and gender. Kaplan Meier time-to-event estimation was used to produce survival curves, and life table technique to estimate 30-day, 90-day, 1-year and overall mortality among hip fracture patients with and without COPD and other comorbidities. Cox regression analysis produced crude and adjusted relative risks (RR) and 95 confidence intervals (CI) for 30-day, 90-day, 1-year and overall mortality following hip fracture associated with COPD and other comorbid conditions. Adjusted RRs for mortality comparing hip fracture patients to population controls without fracture were also computed.;Results. The study population (n=11,985) was followed for an average of 22 months, 71.4% was female, and the mean age was 80 years (range 40-109). The adjusted 30-day, 90-day, 1-year and cumulative mortality following hip fracture was 60-70% greater among patients with a history of COPD. Additional comorbidities that conferred from 1.5 to 3-fold higher risk of mortality at 1 year include congestive heart failure, dementia, tumor, leukemia, lymphoma and metastasis. When compared to age and gender matched controls without hip fracture, hip fracture increased 1-year mortality over 2-fold.;Conclusions. These results demonstrate both the importance of comorbidities, including COPD on subsequent mortality following hip fracture, as well as the strong independent risk of mortality conferred by hip fracture alone. Prevention of hip fracture and appropriate treatment of concurrent medical conditions should all be priorities in an attempt to improve survival in this population.