Risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawai'i: higher mortality risk among Native Hawaiians and other Pacific Islanders.

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Osteoporosis International Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI:10.1007/s00198-024-07195-1

Luke Taylor, Masako Matsunaga, Hyeong Jun Ahn, Andrea M Siu, Sian Yik Lim

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Abstract

We studied factors affecting osteoporotic hip fracture mortality in Hawai'i, a region with unique geography and racial composition. Men, older adults, higher ASA score, lower BMI, and NHPI race were associated with higher mortality. This is the first study demonstrating increased mortality risk after hip fracture in NHPI patients.

Purpose: To estimate mortality rates and identify specific risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawai'i.

Methods: A retrospective review of adults (≥ 50 years) hospitalized with an osteoporotic hip fracture at a large multicenter healthcare system in Hawai'i from 2011 to 2019. The Kaplan-Meier curves and log-rank tests examined survival probability by sex, age group, race/ethnicity, primary insurance, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status classification. After accounting for potential confounders, adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were obtained from Cox proportional hazards regression models.

Results: We identified 1755 cases of osteoporotic hip fracture. The cumulative mortality rate 1 year after fracture was 14.4%. Older age (aHR 3.50; 95% CI 2.13-5.76 for ≥ 90 vs 50-69), higher ASA score (aHR 5.21; 95% CI 3.09-8.77 for ASA 4-5 vs 1-2), and Native Hawaiian/Pacific Islander (NHPI) race (aHR 1.84; 95% CI 1.10-3.07 vs. White) were independently associated with higher mortality risk. Female sex (aHR 0.64; 95% CI 0.49-0.84 vs male sex) and higher BMI (aHR 0.35; 95% CI 0.18-0.68 for obese vs underweight) were associated with lower mortality risk.

Conclusion: In our study, men, older adults, higher ASA score, lower BMI, and NHPI race were associated with significantly higher mortality risk after osteoporotic hip fracture. NHPIs are an especially vulnerable group and comprise a significant portion of Hawai'i's population. Further research is needed to address the causes of higher mortality and interventions to reduce hip fractures and associated mortality.

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夏威夷骨质疏松性髋部骨折后 1 年死亡率的相关风险因素：夏威夷原住民和其他太平洋岛民的死亡风险较高。

我们研究了影响夏威夷地区骨质疏松性髋部骨折死亡率的因素，该地区具有独特的地理和种族构成。男性、老年人、较高的 ASA 评分、较低的体重指数和 NHPI 种族与较高的死亡率有关。目的：估算死亡率并确定与夏威夷骨质疏松性髋部骨折后 1 年死亡率相关的特定风险因素：对 2011 年至 2019 年在夏威夷大型多中心医疗保健系统中因骨质疏松性髋部骨折住院的成人（≥ 50 岁）进行回顾性研究。卡普兰-梅耶曲线和对数秩检验按性别、年龄组、种族/人种、主要保险、体重指数（BMI）和美国麻醉医师协会（ASA）身体状况分类对生存概率进行了检验。在考虑了潜在的混杂因素后，Cox 比例危险回归模型得出了调整后的危险比（aHR）和 95% 的置信区间（CI）：我们发现了 1755 例骨质疏松性髋部骨折病例。骨折后 1 年的累积死亡率为 14.4%。年龄越大（aHR 3.50；95% CI 2.13-5.76 for ≥ 90 vs 50-69）、ASA 评分越高（aHR 5.21；95% CI 3.09-8.77 for ASA 4-5 vs 1-2）、夏威夷原住民/太平洋岛民（NHPI）种族（aHR 1.84；95% CI 1.10-3.07 vs. 白人），死亡风险越高。女性性别（aHR 0.64；95% CI 0.49-0.84 vs 男性性别）和较高的体重指数（aHR 0.35；95% CI 0.18-0.68 肥胖 vs 体重不足）与较低的死亡风险相关：在我们的研究中，男性、老年人、较高的 ASA 评分、较低的体重指数和 NHPI 种族与骨质疏松性髋部骨折后较高的死亡风险有关。非夏威夷裔是一个特别脆弱的群体，占夏威夷人口的很大一部分。需要进一步开展研究，以找出死亡率较高的原因，并采取干预措施降低髋部骨折及相关死亡率。

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来源期刊

Osteoporosis International 医学-内分泌学与代谢

CiteScore

8.10

自引率

10.00%

发文量

224

审稿时长

3 months

期刊介绍： An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.