https://orcid.org/0000-0001-5473-9386
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Abstract
Background and Purpose
Patients with hip fractures often have comorbidities, but detailed data on comorbidity and its impact on prognosis are lacking. We described the current trends in the prevalence of comorbidity and the magnitude of the associated mortality.
Patients and Methods
From the Danish Multidisciplinary Hip Fracture Registry we included 31,443 hip fracture patients (diagnosed in 2014–2018). We calculated the prevalence of individual diseases and comorbidity measured with the Charlson Comorbidity Index (CCI), the Elixhauser Index, and the Rx-Risk Index. We calculated sex and age-adjusted odds ratios (aORs) for 30-day mortality and hazard ratios (aHRS) for one-year mortality with 95% confidence intervals (CI).
Results
The most common diseases identified with the CCI were cerebrovascular diseases (18%), malignancies (17%), chronic pulmonary disease (14%), and dementia (11%). Using the Elixhauser Index, hypertension (37%), cardiac arrhythmias (21%), and fluid and electrolyte disorders (15%) were most prevalent, while ischemic heart disease (42%), hypertension (39%), and use of antiplatelets (37%) were most prevalent when using the Rx-Risk Index. Using the Rx-Risk Index, only 28% of patients had no comorbidity compared to 38% for CCI and 44% for the Elixhauser Index, and the prevalence was stable through the years. Compared to patients with no comorbidity, patients with very severe comorbidity had an aORs for 30-day mortality of 2.6 (CI: 2.4–2.9) using CCI, 2.6 (CI: 2.4–3.1) using the Elixhauser Index, and 3.1 (CI: 2.7–3.4) using the Rx-Risk Index.
Interpretation
More than 50% of the patients with hip fractures have moderate to very severe comorbidity, with considerable variation between indices. The prevalence of individual diseases varies considerably. All indices had comparable dose-response associations with mortality. These results are relevant for clinicians to amend prevention and target care, and for researchers to decide which comorbidity measure to use depending on the research question.
Compliance with Ethical Standards
The study was reported to the Danish Data Protection Agency through registration at Aarhus University (record number: AU-2016-051-000001, sequential number 880).
Acknowledgment
We thank the staff at the hospital departments caring for patients with hip fractures for their continuous efforts and contribution to the acquisition of the data in the Danish Multidisciplinary Hip Fracture Registry.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Mr Madsen reports that he is involved in studies with funding from various companies as research grants to (and administered by) Aarhus University. The authors declare that they have no other conflicts of interest in this work.