标题：Hip Fracture Risk Among Community-Dwelling Elderly People in the United States: A Prospective Study of Physical, Cognitive, and Socioeconomic Indicators
摘要：Objectives. We determined risks of short-term (2-year) hip fracture in a nationally representative, prospective cohort of community-dwelling elderly people 70 years or older. Methods. We used self-report data from 2 waves of the Asset and Health Dynamics Survey (n = 5630). Sample-weighted logistic regression analyses were conducted to determine risk of hip fracture in relation to several demographic, cognitive, physical, and socioeconomic indicators. Results. During the 2-year study period, 102 participants reported a new hip fracture. Several indicators of physical functioning and cognitive status, including incorrect delayed word recall and inability to lift 10 lbs (4.5 kg), were significantly associated with hip fracture risk. In the final model, mobile home residents, individuals without Medicare part B insurance, and those without a high-school diploma were at more than a 2-fold risk of hip fracture. Educational level, physical functioning, and insurance status were the top 3 contributors to hip fracture risk. Conclusions. In addition to functional status measures, health insurance status, educational level, and type of residence appear to be independent predictors of hip fracture. Hip fracture is one of the most serious and debilitating injuries among older individuals. The 1-year mortality rate among elderly people after a hip fracture is 20%, and a significant proportion of survivors are admitted to nursing homes, approximately half with permanently limited physical functioning. 1 , 2 After the age of 65 years, half of White women and one quarter of White men will sustain at least 1 osteoporotic fracture. 3 In addition, expenditures on hip fractures and their related medical care are increasing. Projections suggest that health care expenditures related to hip fracture, which were at a level of $2.9 billion in 1991, are expected to exceed $20 billion per year as of 2006. 4 – 8 During the past 3 decades, several countries have seen an increase in the age-adjusted incidence of trochanteric hip fractures, and at least 1 analysis has reported an increase in successive birth cohorts, suggesting that factors other than those generally associated with aging are playing a role. 9 – 14 Factors commonly associated with hip fracture among the elderly include female gender, White race, advanced age, osteoporosis, previous hip fracture, level of physical functioning, medication use, and hormonal and dietary factors. 15 Other measures of short-term risk among community-dwelling elderly people, particularly those that are relatively simple to administer in the clinic or via telephone, may be important in promoting hip fracture prevention. We assessed short-term (2-year) hip fracture risks among a representative sample of elderly African Americans, Hispanics, and non-Hispanic Whites residing in the United States.
