Hip fracture incidence in the elderly in Austria: An epidemiological study covering the years 1994 to 2006

Mann E, Icks A, Haastert B, Meyer G. Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006. BMC Geriatrics. 2008;8(1): 35.Background: Hip fractures in the elderly are a major public health burden. Data concerning secular trends of hip fracture incidence show divergent results for age, sex and regions. In Austria, the hip fracture incidence in the elderly population and trends have not been analysed yet. Methods: Hip fractures in the population of 50 years and above were identified from 1994 to 2006 using the national hospital discharge register. Crude incidences (IR) per 100,000 person years and standardised incidences related to the European population 2006 were analysed. Estimate of age-sex-adjusted changes was determined using Poisson regression (incidence rate ratios, IRRs). Results: The number of hospital admissions due to hip fracture increased from a total number of 11,694 in 1994 to 15,987 in 2006. Crude incidences rates (IR) per 100.000 for men increased from 244.3 (95% confidence interval (CI) 234.8 to 253.7) in 1994 to IR 330.8 (95% CI 320.8 to 340.9) in 2006 and for women from 637.3 (95% CI 624.2 to 650.4) in 1994 to IR 758.7 (95% CI 745.0 to 772.4) in 2006. After adjustment for age and sex the annual hip fracture incidence increase was only small but statistically significant (IRR per year 1.01, 95% CI 1.01 to 1.01, p < 0.01). Change of IRR over the 12 years study period was 13%. It was significantly higher for men (IRR over 12 years 1.21, 95% CI 1.16 to 1.27) than for women (IRR over 12 years 1.10, 95% CI 1.06 to 1.14) (interaction: p = 0.03). Conclusion: In contrast to findings in other countries there is no levelling-off or downward trend of hip fracture incidence from 1994 to 2006 in the Austrian elderly population. Further investigations should aim to evaluate the underlying causes in order to plan effective hip fracture reduction programmes

Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: An epidemiological study

Mann E, Meyer G, Haastert B, Icks A. Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study. BMC Public Health. 2010;10(1): 46.Background Several studies evaluated variations in hip fracture incidences, as well as trends of the hip fracture incidences. Comparisons of trends are lacking so far. We compared the incidence rates and, in particular, its trends between Austria and Germany 1995 to 2004 analysing national hospital discharge diagnosis register data. Methods Annual frequencies of hip fractures and corresponding incidences per 100,000 person years were estimated, overall and stratified for sex and age, assuming Poisson distribution. Multiple Poisson regression models including country and calendar year, age and sex were used to analyse differences in incidence and trend. The difference of annual changes between the two countries was explored using an interaction term (calender year * country). Results Overall, the increase of hip fracture risk was 1.31 fold higher (95% CI 1.29-1.34) in Austria compared to Germany, adjusted for age, sex, and calendar year. The risk increase was comparable for both sexes (males: RR 1.35 (1.32-1.37), females: RR 1.31 (1.29-1.33)). Hip fracture trend from 1995 to 2004 indicates an increase in both countries without a statistically significant difference between Austria and Germany (interaction term: p = 0.67). Conclusion In this study comparing hip fracture incidences and its trend using pooled data, the incidence in Austria was 30% higher compared to its neighbouring country Germany. For both countries a similar increasing trend of hip fracture incidence over the 10-year study period was calculated. The results need confirmation by other studies

Hip fractures and area level socioeconomic conditions: a population-based study

Icks A, Haastert B, Wildner M, et al. Hip fractures and area level socioeconomic conditions: a population-based study. BMC Public Health. 2009;9(1):114.Background: Only a limited number of studies have analyzed the association between hip fracture incidence and socioeconomic conditions. Most, but not all found an association, and results are in part conflicting. The aim of our study was to evaluate the association between hip fractures and socioeconomic conditions in Germany, from 1995 to 2004, on a census tract area level. Methods: We used data from the national hospital discharge diagnosis register and data on socioeconomic and demographic characteristics of 131 census tracts from official statistics. Associations between the hip fracture incidence and socioeconomic conditions were analyzed by multiple Poisson regression models, taking overdispersion into account. Results: The risk of hip fracture decreased by 4% with a 7% increase (about one interquartile range) of non-German nationals. It decreased by 10% with a 6% increased rate of unemployment, increased by 7% with a 2% increase of the proportion of welfare recipients, and also increased by 3% with an increase of the proportion of single parent families of 1.9%. Conclusion: Our results showed weak associations between indicators of socioeconomic conditions at area level and hip fracture risk; the varied by type of indicator. We conclude that hip fracture incidence might be influenced by the socioeconomic context of a region, but further analysis using more specific markers for deprivation on a smaller scale and individual-level data are needed

Trend of hip fracture incidence in Germany 1995-2004: a population-based study

Icks A, Haastert B, Wildner M, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: a population-based study. OSTEOPOROSIS INTERNATIONAL. 2008;19(8):1139-1145.We analyzed hip fracture incidence trends in Germany 1995-2004, using national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p<0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. Introduction Data concerning actual trends of the hip fracture incidence and differences for sex, age, and region are limited. We analyzed hip fracture incidence trends in Germany 1995-2004, using the national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p<0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. Methods Analysis of annual hip fracture incidences using the national hospital discharge register. Estimate of age-sex-adjusted changes was found by using Poisson regression (incidence rate ratios, IRR). Results The number of patients with at least one hospital admission for hip fracture increased (1995: n=99,141; 2004: n=116,281). Crude incidences per 100,000 were 121.2 (95% confidence interval 120.5-121,9) and 140.9 (140.2-141.7), respectively. The age-sex-adjusted hip fracture incidence increased statistically significantly, but only slightly (IRR per year: 1.01; 1.00-1.01; IRR 1995-2004: 1.05, p<0.01). In men aged 40 years or older, incidences increased. In women, there was a tendency of a decrease up to 74 years of age, but also a significant increase in higher age groups. In people 0-39 years, the incidence declined markedly (IRR 1995-2004, men 0.74; 0.69-0.79, women 0.62; 0.55-0.69, both p<0.01). The increase was significantly higher in Eastern compared to Western Germany (interaction: p=0.002), and differences between East and West decreased. Conclusions In contrast to earlier years, the hip fracture incidence in Germany 1995-2004 increased only slightly, with a decline in younger people, but increases in older ages, particularly in men. Regional differences decreased