Research Article: The incidence and factors of hip fractures and subsequent morbidity in Taiwan: An 11-year population-based cohort study

Date Published: February 15, 2018

Publisher: Public Library of Science

Author(s): Kai-Biao Lin, Nan-Ping Yang, Yi-Hui Lee, Chien-Lung Chan, Chi-Hsu Wu, Hou-Chuan Chen, Nien-Tzu Chang, Tuan Van Nguyen.


Hip fractures are a major problem to elder population, but subsequent morbidity is unclear about environmental factors and socioeconomic conditions. The study aims to investigate the incidence of hip fractures treated by the surgery; to compare the sequelae and temporal trends of hip fractures; to evaluate the seasonal effects in the subsequent short-term and long-term morbidities after hip fractures. A cohort study design is conducted using national health research datasets between 2000 and 2010. The ICD-9-CM diagnostic codes were utilized to investigate the incidence of hip fractures and the corresponding treatments. Hierarchical modeling was used to analyze the factors associated with various types of hip fractures. The results indicated that females had a lower incidence in the 30–44 age group, but a significantly higher incidence than males among those aged 60 years or older (adjusted rates 232.1 vs. 100.3 per 100,000 persons, p<0.001). The incidence of hip fractures in the low-income group showed no significant difference compared to that in the general population. There was a temporal trend of a 8.6% increase in the incidence of all types of hip fractures over the period of 2000–2010. A summer-winter variation is observed among the elderly. Hip fractures and subsequent morbidity are increasing in Taiwan’s aging society. Older age, female gender, and time periods were independent risk factors for subsequent morbidities after surgical treatment. The result of this study is useful to the healthcare policy makers and to raise the public awareness of hip fractures.

Partial Text

Hip fractures are a major threat to the survival of affected individuals associated with a high mortality rate (14–36%) and morbidity [1, 2]. Fatalities are often not caused by the hip fracture itself, but associated traumatic injuries [2]. It has been estimated that the mortality of the hip fracture patients in thirty days is 19%. The mortality in one year after hip fracture surgery is 20% to 30% [3]. After hip-fracture surgery, only few patients regained their physical function [4, 5]. Understanding traumatic injury and its subsequent adverse impacts are preventive issues and public concerns.

Hip fractures are a major cause of disability and the most costly type of fracture for the health care services [21], especially for an aging society. The deterioration controls and magnitude of risk management to prevent long-term adverse effects after hip fracture surgery are urgently public concerns. Based on nationwide data, our study documented the year trends of incidence of hip fractures and subsequent morbidity in Taiwan between 2000 and 2010. This national database was established by evidence-based records and doctor-recognized diagnoses which are more reliable and accurate than self-reported diseases in a primary survey. This longitudinal study has several strengths. Large data analysis has shown great potential in underlying valuable insights. Few previous studies were conducted using this method with such a large amount of medical data and providing clear information to their long-term impact to guide clinical practitioners [22]. A complete understanding of prognostic information related to outcomes is required and incorporated in order to reduce the burden of hip fractures and to plan strategies for care.




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