Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study

Abstract

Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

One-year mortality after hip fracture surgery: urban–rural differences in the Colombian Andes

“…In Latin America, the hip fracture rates are similar to the values reported in North America [ 4 ], while urban–rural differences in hip fracture prevalence are well documented, with higher rates in urban areas [ 7 ]. However, urban–rural differences in hip fracture mortality are more confusing, with some studies showing no increase [ 8 ], others finding higher mortality in rural areas [ 9 , 10 ], and others finding higher mortality in urban areas [ 11 ]. Several explanations have been proposed for these contradictory findings: differences in general health in urban–rural populations, including multimorbidity, could be an important reason [ 12 ], and other factors, such as demographics and socioeconomic, social, and environmental factors, could contribute to this difference [ 11 , 13 ], as well as inequalities between urban and rural municipalities regarding follow-up health care services or rehabilitation services [ 11 ].…”

Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study

“…In contrast, a Norwegian nationwide study found an increasing degree of urbanization was associated with higher post-fracture mortality, especially the first 1 to 2 years post-fracture [38], which might reflect a higher level of fragility in urban residents. Another Norwegian study demonstrated that urban women had lower BMD, lower BMI, and a higher proportion of poor or fair self-reported health than rural women [39].…”

A csípőtáji töréseket követő intézményi rehabilitációra utalás gyakorlata és a beutalást befolyásoló tényezők a hazai közfinanszírozási adatok alapján

“…Több cikk említi tényezőként a betegnek a sérülés előtti lakóhelyét is. Ezek elsősorban a saját otthonukban és a szociális ellátóintézményekben lakó betegek csoportjait különböztetik meg [24,29,30], de említésre kerül a városi és a vidéki ellátás különbsége is [24,30]. A dementia több közlemény szerint hátrányosan befolyásolja a rehabilitációra kerülést [23][24][25], hiszen hatással van az együttműködési képességre, bár a gyógytorna a demens betegekre is kedvezően hat [31].…”

“…A rehabilitációra kerülést vagy a rehabilitáció kimenetelét befolyásoló társbetegségek közül kiemelendők a szív-ér rendszeri betegségek (például korábbi szívinfarktus, coronariasztent), a magas vérnyomás, a diabetes, a krónikus obstruktív tüdőbetegség (COPD), az akut ellátás során beadott transzfúzió, valamint a beteg kognitív állapotára utaló diagnózisok [17,[25][26][27]32]. A beteg lakóhelye a beteg önállóságáról, szociális helyzetéről és az ellátáshoz való hozzáférésről is képet adhat [30].…”

“…A beteg együttműködési képességét befolyásoló társbetegségek (dementia, mentális betegségek, alkoholbetegség) esetében szignifikánsan kisebb esélye van az intézményi rehabilitációs ellátásnak. Ezen megállapításaink összhangban vannak a szakirodalommal [23][24][25][26][27][28][29][30][31][32], és a betegállapot-jellemzők eredményei tükrözik a szakmai ajánlásokban megfogalmazott követelményeket [21,22].…”