Recent Hospitalization and the Risk of Hip Fracture Among Older Americans

Background. We identified hip fracture risks in a prospective national study. Methods. Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline hospitalizations was included. Results. A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and = 85 year age groups vs those aged 70-74 years; p values < .001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <. 001 and <. 01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <. 001, <. 05, and <. 01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <. 05 and <. 001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001). Conclusions. Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates