Full Length ArticleThe epidemiology of hip fractures across western Victoria, Australia
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
References (54)
- et al.
Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study
Bone
(2015) - et al.
Incident hip fracture and social disadvantage in an Australian population aged 50 years or greater
Bone
(2011) - et al.
Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status?
Public Health
(2004) - et al.
Incidence of hip fracture in Oslo, Norway: differences within the city
Bone
(1998) - et al.
Secular increase and geographical differences in hip fracture incidence in Norway
Bone
(1993) - et al.
Social determinants of bone densitometry uptake for osteoporosis risk in patients aged 50 yr and older: a systematic review
J. Clin. Densitom.
(2012) - et al.
Behavioural and physical characteristics associated with vitamin D status in women
Bone
(2009) - et al.
Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008
Soc. Sci. Med.
(2011) - et al.
The association between urban or rural locality and hip fracture in community-based adults: a systematic review
J. Epidemiol. Community Health
(2010) - et al.
Epidemiology of hip fracture: worldwide geographic variation
Indian J. Orthop.
(2011)
The effect of surgical timing on the outcome of patients with neck of femur fracture
Arch. Orthop. Trauma Surg.
Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987–2002
Scand. J. Public Health
Total length of stay, costs and outcomes at final discharge for admitted patients with hip fracture: linked episode data for Australian veterans and war widows
Intern. Med. J.
Osteoporosis costing all Australians a new burden of disease analysis—2012 to 2022
Bone mineral density and incidence of hip fracture in Swedish urban and rural women 1987–2002
Acta Orthop.
Changes in hip fracture rates in southeastern Australia spanning the period 1994–2007
J. Bone Miner. Res.
Risk factors for cervical and trochanteric hip fractures in elderly women: a population-based 10-year follow-up study
Calcif. Tissue Int.
Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study
BMC Geriatr.
The role of socioeconomic status on hip fracture
Osteoporos. Int.
Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures
ANZ J. Surg.
Geographic variation in osteoporotic hip fracture incidence: the growing importance of Asian influences in coming decades
J. Osteoporos.
Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly
Osteoporos. Int.
Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study
J. Epidemiol. Community Health
Regional differences in hip fracture risk in Turkey
Bone
Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly
Osteoporos. Int.
Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time
Osteoporos. Int.
Undertreatment of osteoporosis in regional Western Australia
Australas. J. Ageing
Cited by (13)
Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: A prospective registry-based study
2020, InjuryCitation Excerpt :These factors are known to increase the likelihood of hip fracture [33], poor recovery and mortality [1, 34]. Areas with greater levels of socioeconomic disadvantage typically have higher incidence of hip fracture [35, 36], especially in rural areas [37]. Moreover, people living in neighbourhoods with higher levels of socioeconomic disadvantage typically have poorer recovery from a range of injury causes and profiles [38, 39].
Perimortem fracture manifestations and mortality after hip fracture in a documented skeletal series
2019, International Journal of PaleopathologyCitation Excerpt :Hip fractures are a significant global health problem in older individuals (Cheung et al., 2018; Holloway et al., 2018).
Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population
2019, BoneCitation Excerpt :We found that hip fracture prevalence among adults aged ≥70 years is significantly higher than in those aged <50 years. Some previous studies also found the risk of hip fracture rose with increasing age [2,11,24]. One study found that the peak number of hip fractures occurred between the ages of 75–79 years [25].
Cross-sectional survey of rehabilitation service availability for stroke and hip fracture in Australian public hospitals
2021, Australian Journal of Rural HealthFragility fracture discriminative ability of radius quantitative ultrasound: a systematic review and meta-analysis
2021, Osteoporosis International