Has Mortality After a Hip Fracture Increased?

OBJECTIVES: To study changes in mortality and causes of death in patients suffering a hip fracture between 1981 and 2001. DESIGN: Historic, register-based cohort study. SETTING: Nationwide cohort study in Denmark. PARTICIPANTS: All 163,313 patients suffering a hip fracture between 1981 and 2001 in Denmark and 505,960 age- and sex-matched controls. INTERVENTIONS: Osteosynthesis, arthroplasty, or other management for the hip fracture. MEASUREMENTS: Mortality and cause of death at 30 days and 1 year. RESULTS: The mean age of the patients with hip fracture increased (from 75.8 in 1981 to 78.1 in 2001, P<.01), and the proportion of men with hip fracture also increased (from 25.5% to 29.8%, P<.01). A statistically significant decrease was observed in crude 1-year survival. Mortality increased in subjects with a hip fracture from 1981/85 to 1986/2001, whereas it decreased among controls. There was significantly greater mortality in patients undergoing arthroplasty (relative risk=1.05, 95% confidence interval=1.03-1.07) than in those undergoing osteosynthesis. Causes of death related to the trauma that caused the fracture explained most of the deaths (68-76%) within the first 30 days after the fracture. CONCLUSION: Significant demographic changes took place, with older people and more men experiencing hip fracture. After adjustment for age, sex, and comorbidity, survival was poorer in patients suffering a hip fracture than in controls. This calls for measures to improve survival.