AIMS This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. METHODS Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. RESULTS Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. CONCLUSION Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: Bone Joint J 2022;104-B(7):884-893.

中文翻译：

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2014 年至 2018 年挪威髋部骨折死亡率的可改变和不可改变的危险因素：一项关联的多注册研究。

目的 本研究旨在确定髋部骨折后死亡率的风险因素（患者、医疗保健系统和社会经济），并估计其相对重要性。此外，我们旨在阐明骨折后的死亡率和生存模式以及超额死亡率的持续时间。方法 2014 年 1 月至 2018 年 12 月挪威髋部骨折登记处 37,394 例髋部骨折的数据与挪威患者登记处、挪威统计局的数据和急症护理医院的特征相关联。进行 Cox 回归分析以估计与死亡率相关的危险因素。Wald 统计量用于估计和说明风险因素的相对重要性，风险因素分为可修改（与医疗保健相关）和不可修改（与患者相关和社会经济）。我们计算了标准化死亡率比 (SMR)，将髋部骨折患者的死亡人数与标准化参考人群的预期死亡人数进行了比较。结果平均年龄为 80.2 岁 (SD 11.4)，67.5% (n = 25,251) 为女性。患者因素（男性、合并症增加（美国麻醉医师协会分级和查尔森合并症指数））、社会经济因素（低收入、低教育水平、住在医疗机构）和医疗保健因素（髋部骨折体积、正畸服务的可用性) 与死亡率增加有关。与可改变的风险因素相比，不可改变的风险因素与死亡率的相关性更强。SMR 分析表明，髋部骨折患者的累积超额死亡率在第一年为 16%，在六年为 41%。SMR 为 2。6 年观察期为 48，第一年最为明显，从第一个月的 10.92 下降到 12 个月后的 3.53 和 6 年后的 2.48。发现中位生存时间存在显着差异，尤其是与患者相关的因素。结论 社会经济、患者和医疗保健相关因素均导致超额死亡率，并且不可改变的因素比可改变的因素具有更强的相关性。髋部骨折导致死亡率大幅增加。显然，微小的生存差异转化为这一老年人群中位生存时间的巨大差异。引用这篇文章：骨关节 J 2022;104-B(7):884-893。发现中位生存时间存在显着差异，尤其是与患者相关的因素。结论 社会经济、患者和医疗保健相关因素均导致超额死亡率，并且不可改变的因素比可改变的因素具有更强的相关性。髋部骨折导致死亡率大幅增加。显然，微小的生存差异转化为这一老年人群中位生存时间的巨大差异。引用这篇文章：骨关节 J 2022;104-B(7):884-893。发现中位生存时间存在显着差异，尤其是与患者相关的因素。结论 社会经济、患者和医疗保健相关因素均导致超额死亡率，并且不可改变的因素比可改变的因素具有更强的相关性。髋部骨折导致死亡率大幅增加。显然，微小的生存差异转化为这一老年人群中位生存时间的巨大差异。引用这篇文章：骨关节 J 2022;104-B(7):884-893。显然，微小的生存差异转化为这一老年人群中位生存时间的巨大差异。引用这篇文章：骨关节 J 2022;104-B(7):884-893。显然，微小的生存差异转化为这一老年人群中位生存时间的巨大差异。引用这篇文章：骨关节 J 2022;104-B(7):884-893。