Is Brazil Prepared for the Hip Fracture Epidemic in the Elderly: A National Ecological Analysis of In‐Hospital Mortality, Regional Disparities, and Hospital Costs (2008–2024)

Objective To analyze temporal trends, regional disparities, and the economic impact of in‐hospital mortality due to femoral fractures among older adults in Brazil between 2008 and 2024. Methods This ecological study was based on data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). In‐hospital mortality rates were calculated per 100,000 inhabitants and stratified by age groups (60–64, 65–69, 70–74, 75–79, and ≥ 80 years) and geographic regions. Temporal trends were assessed using simple linear regression. Results During the study period, 45,405 deaths due to femoral fractures among older adults were recorded during the first hospital admission. The national in‐hospital mortality rate increased from 0.87 per 100,000 inhabitants in 2008 to 1.10 per 100,000 inhabitants in 2024. The ≥ 80‐year age group exhibited the highest mortality rates (mean: 60.7 ± 8.69), whereas the 60‐ to 64‐year group showed the lowest values (0.59 ± 0.36). The Southeast and South regions presented the highest age‐adjusted mortality rates, with marked regional heterogeneity and wider confidence intervals observed in the North and Northeast regions. A sustained upward trend in mortality was identified, particularly among the oldest‐old population, concomitant with a substantial increase in hospital‐related costs. Conclusion In‐hospital mortality due to femoral fractures among older adults in Brazil demonstrates a rising trend, significant regional inequalities, and a considerable economic burden. These findings suggest that, in the context of rapid population aging, Brazil remains insufficiently prepared to address the growing epidemic of femoral fractures, underscoring the need for integrated public health policies, structured care pathways, and multidisciplinary protocols focused on geriatric trauma care.