Elsevier

Bone

Volume 108, March 2018, Pages 1-9
Bone

Full Length Article
The epidemiology of hip fractures across western Victoria, Australia

https://doi.org/10.1016/j.bone.2017.12.007Get rights and content

Highlights

  • Hip fractures rates varied across different geographical areas.

  • Increasing remoteness was associated with an increase in hip fracture rates.

  • Increasing socioeconomic status was associated with a decrease in hip fracture rates.

  • Most patients had an acute hospital care length of stay ≤ 14 days.

  • Men appeared to have longer lengths of stay for acute hospital care than women.

Abstract

Background

Hip fractures are associated with considerable morbidity and mortality. Hip fracture incidence varies across different levels of accessibility/remoteness and socioeconomic status (SES). As part of the Ageing, Chronic Disease and Injury Study, we aimed to map the pattern of hip fractures across the western region of the Australian state of Victoria, which contains a range of remoteness levels and SES.

Methods

Data on hip fractures resulting in hospital admission were extracted from the Victorian Admitted Episodes Dataset (VAED) for men and women aged 40 + years during 2010–2013 inclusive. An age-adjusted incidence rate (per 10,000 population/year) was calculated for the entire region. Crude incidence rates and length of acute care hospital stay (excluding rehabilitation) were calculated for each Local Government Area (LGA). The impact of aggregated age, accessibility/remoteness index of Australia (ARIA) and SES on hip fracture rates aggregated across LGAs was determined using Poisson regression.

Results

For men, the age-standardised rate of hospitalisations for hip fracture across the whole region was 19.2 per 10,000 population/year (95%CI 18.0–20.4) and for women, 40.0 (95%CI 38.3–41.7). The highest incidence rates for both sexes occurred in the less accessible LGAs of Yarriambiack and Hindmarsh, as well as the LGA with the lowest SES, Central Goldfields. In both sexes, approximately two thirds of individuals were discharged from acute hospital care within 14 days. Increasing age, higher remoteness and lower SES were all associated with higher hip fracture rates.

Conclusion

Crude incidence rates varied by location. Given that a high proportion of patients had acute hospital care of ≤ 14 days, and accessibility and SES were associated with hip fracture rates, these results can inform policy and provide a model for other groups to conduct similar research in their local environment.

Introduction

Hip fractures are associated with considerable morbidity and can lead to decreased quality of life, chronic pain, disability, increased demand on health infrastructure and institutionalisation, as well as an increase in mortality [1], [2], [3], [4]. Hip fractures are a significant public health issue for both sexes; one in three hip fractures occur in men and mortality is 2–3 times higher than in women [5]. Hip fractures are also associated with extended hospital stays and significant hospitalisation costs. In Australia, between 2008 and 2009, older men and women who sustained hip fractures had a mean length of stay (including readmissions) of 30.8 days, and mean hospitalisation cost between AUD$23,243 and AUD$33,576 per admission [6], [7]. The incidence of hip fractures seems to have stabilised or even declined in developed countries [3], [5], [8], [9], however, the absolute numbers of hip fractures and additional comorbidities are increasing due to an ageing population [3], [10].

Risk factors for hip fractures include advanced age, female sex, greater height, low bone mineral density (BMD), low body mass index (BMI), comorbidities, smoking, drinking (alcohol), reduced cognitive function, impaired vision, medication use, impaired balance, physical inactivity and falls [10], [11], [12]. Place of residence is also an important risk factor for hip fractures and length of stay post-fracture [13]. Geographical variations in hip fracture rates between countries, and in different regions in the same country, have been reported [2], [14]. For example, hip fracture rates are nearly seven times higher in northern, compared to southern, European countries [2], [14]. A similar pattern exists across North America, where the more northern states of America have a higher hip fracture rate than southern states [2].

Residents of urban areas have been reported to have a ~ 30% higher risk of hip fracture than residents of rural areas and data suggest that this is not entirely due to the preferential placement of aged-care institutions in urban areas [15], [16]. Previous studies have also reported that individuals living in urban areas have lower BMD, which may contribute to higher hip fracture rates [1], [12], [17], [18]. A higher incidence of fractures at all skeletal sites in urban areas has also been reported in the USA [19] and in Australia [16]. However, this pattern is not supported in all studies. In Australia, health is generally poorer in rural residents due to lesser accessibility to health services and migration of older individuals away from urban areas following retirement [20]. Individuals living in rural areas are three times less likely to undergo BMD testing, are less likely to use vitamin D supplements, calcium supplements or bisphosphonates and thus are less likely to be aware that they have osteoporosis, or receive treatment to manage osteoporosis, than individuals who live in an urban area [20]. Socioeconomic status (SES), measured at the area-level (rather than an individual level), is another factor that affects hip fracture incidence. A higher incidence of hip fractures has been reported in areas with lower SES, which may be mediated by a lower BMD in lower SES areas [12], [18], [21]. Our data on the impact of SES on major osteoporotic fractures (including hip fracture) also indicated that individuals with lower SES had higher rates of these type of fractures [22]. However, a few studies have reported a lower hip fracture incidence in lower SES areas [3], [23] and one reports no association between SES and hip fracture rates [24].

This study forms part of the larger Ageing, Chronic Disease and Injury (ACDI) study [25], which aims to map the pattern of chronic diseases and injury across the western region of the Australian state of Victoria. The ACDI study region includes urban, rural and agricultural areas, with a range of SES. The ability to identify gaps in healthcare service delivery, as well as implement intervention and prevention strategies is dependent upon obtaining contemporary data. The ACDI study will provide this type of data, allowing targeted resource allocation to effectively manage the burden of chronic disease and injury, as well as demonstrating a profiling model which can be used in other geographical regions, particularly in non-metropolitan settings. Studies from this region will also allow assessments of internal (in region) changes in health practices and how these impact healthcare, as well as comparison to other regions. This may allow broader validation of not only hip fractures, but also a range of other drivers of fractures and healthcare outcomes. This study aimed to investigate the incidence of hip fractures in men and women aged 40 + years as part of the larger ACDI study.

Section snippets

Study region

Australia comprises eight states and territories; the state of Victoria is the second most populous (Fig. 1). In Victoria, there are 79 clearly-defined geographical regions known as Local Government Areas (LGAs). The study region includes 21 of these 79 LGAs, making up nearly one-third of the state by area. In 2011, the estimated residential population for the study region was 617,794, representing ~ 11% of the population in Victoria. The study region encompasses a large number of individuals

Whole study region

During the study period, there were 1305 fractures sustained by men and 2903 by women. The incidence rate of hip fractures across the entire region increased with age for both men and women (Fig. 2a). For men, the rate ranged from 2.8 per 10,000 population/year (95%CI 2.0–3.7) in the 40–49 year age-group to 37.3 (95%CI 33.2–41.7) in the 70–79 year age-group and 159.4 (95%CI 148.1–171.3) in the oldest age-group (80 + years). For women, the rate ranged from 0.4 per 10,000 population/year (95%CI

Discussion

This study examined age-adjusted fracture incidence rates for hospital admission due to hip fracture across the western Victorian region of Australia. Incidence rates and acute length of stay differed across LGAs according to ARIA and IRSAD scores. Incidence rates were highest in the western rural LGAs of Hindmarsh and Yarriambiack, as well as the central rural LGA of Central Goldfields, which has the lowest IRSAD score in the state of Victoria. Length of acute care hospital stay also varied

Conclusion

The age-adjusted incidence rates for hospital admission due to hip fracture were calculated for the entire western Victoria region, in Australia. The rates across the region were higher in women than men. Three rural LGAs in the west and central areas of the study region had higher crude incidence rates than others. Across all LGAs overall, women had higher rates of hip fracture than men. Across the entire region, approximately one third of patients had an acute care length of stay longer than

Acknowledgements

The study is funded by the Western Alliance Academic Health Science Centre, a partnership for research collaboration between Deakin University, Federation University and 13 health service providers operating across western Victoria. MAS is supported by an IMPACT Strategic Research Centre (Deakin University) stipend. SLB-O and LJW are supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship (1107510 and 1064272, respectively) and KLH is supported by an

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