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dc.contributor.authorKjærvik, Cato
dc.contributor.authorGjertsen, Jan-Erik
dc.contributor.authorStensland, Eva
dc.contributor.authorSaltete-Benth, Jurate
dc.contributor.authorSøreide, Odd
dc.date.accessioned2022-08-09T08:50:02Z
dc.date.available2022-08-09T08:50:02Z
dc.date.issued2022-07-01
dc.description.abstract<p><i>Aims</i> This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. <p><i>Methods</i> Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. <p><i>Results</i> Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. <p><i>Conclusion</i> Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population.en_US
dc.identifier.citationKjærvik C, Gjertsen JE, Stensland E, Saltete-Benth, Søreide O. Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018 - a linked multiregistry study. The Bone & Joint Journal. 2022;104(7):884-893en_US
dc.identifier.cristinIDFRIDAID 2037299
dc.identifier.doihttps://doi.org/10.1302/0301-620X.104B7.BJJ-2021-1806.R1
dc.identifier.issn2049-4394
dc.identifier.issn2049-4408
dc.identifier.urihttps://hdl.handle.net/10037/26027
dc.language.isoengen_US
dc.publisherBone & Joint Publishingen_US
dc.relation.ispartofKjærvik, C. (2022). Hip fractures in Norway – Inequity in treatment and outcomes. (Doctoral thesis). <a href=https://hdl.handle.net/10037/27134>https://hdl.handle.net/10037/27134</a>.
dc.relation.journalThe Bone & Joint Journal
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2022 The Author(s)en_US
dc.titleModifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018 - a linked multiregistry studyen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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