Fracture associated mortality - how much is due to the fracture versus co-morbidity: the 45 and up study — ASN Events
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Fracture associated mortality - how much is due to the fracture versus co-morbidity: the 45 and up study (#32)

Weiwen Chen 1 , Fiona Blyth 2 , Lyn March 2 3 , Judy M Simpson 2 , Jackie R Center 1 4
  1. Garvan Institute, Darlinghurst, NSW, Australia
  2. University of Sydney, Camperdown, NSW
  3. Kolling Insitute of Medical Research, Sydney
  4. St Vincent's Hospital, St Vincent's Hospital Clinical School, Darlinghurst, NSW, Australia

Introduction: Increased mortality is recognised following hip, vertebral and more recently, non-hip non-vertebral fractures. Controversy exists regarding the contribution of fracture as an independent risk factor for mortality.

Objective: To examine the contribution of fracture, independent of co-morbidities, to mortality in women and men.

Design, Setting, and Participants: Prospective population-based cohort study of 267,043 women and men from the 45 and Up Study, New South Wales, Australia. Baseline questionnaire data were linked to routinely collected hospital administrative and all-cause mortality data from February 1, 2006 to December 31, 2013.  Associations between fracture and mortality were examined using Cox proportional hazards models, adjusted for age, lifestyle factors and co-morbidities of cardiovascular disease, diabetes, stroke, thrombosis and cancer. Population attributable risk fraction for mortality was studied for every level of risk exposure to fracture, and the co-morbidities.

Results: During the 1,490,651 person-years of follow-up, women experienced 7,571 fractures and 7,064 deaths, whilst men experienced 4,571 fractures and 11,078 deaths. Overall, participants with fractures had higher mortality rates than those without. All proximal fractures were associated with increased mortality.  Adjusted mortality hazard ratios ranged from 1.3 to 3.4. Fracture and co-morbidity had independent effects on mortality with each additional co-morbidity adversely impacting the increased mortality associated with fracture (Figure 1). Population attributable risk for mortality for any fracture without any co-morbidity was 8.5% in women and 4% in men, similar to or greater than that for a single co-morbidity such as diabetes alone.

Conclusion: All sites of proximal fractures in both women and men were associated with increased mortality risk. Co-existent co-morbidities independently and further increased this fracture associated mortality. Population attributable risk for mortality for any fracture was similar to that of diabetes highlighting the magnitude and impact of low trauma fractures and thus the need for early intervention and treatment.

 

 

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