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© 2007 American Public Health Association
DOI: 10.2105/AJPH.2007.116897
LETTER |
Andrea Icks is with the Faculty of Public Health, Bielefeld University, Düsseldorf, Germany, and the North-Rhine Westphalian Chamber of Physicians, Düsseldorf. Burkhard Haastert is with mediStatistica, Neuenrade, Germany. Gabriele Meyer is with the University of Bremen, Institute of Public Health and Nursing, Bremen, Germany.
Correspondence: Request for reprints should be sent to Andrea Icks, MD, DrPH, North-Rhine Westphalian Chamber of Physicians, Tersteegenstr. 9, D-40474 Düsseldorf, Germany (e-mail: dr.andrea.icks{at}aekno.de).
Hip fractures have a large economic impact because of the requirement of hospital and follow-up care, in addition to causing substantial health deterioration.1 Numerous studies have presented trends of hip fracture incidence, focusing on people aged 45 or 50 years and older.2,3 Data on younger age groups has not been discussed yet. Analyses of trends for injury-related hospitalization do not separately report hip fractures3–5 as do analyses of other injuries (e.g., traumatic brain injury).6 The majority of hip fractures occur in older age groups because of low mineral bone mass, which leads to an increased risk of fall-related fractures. However, a substantial proportion of hip fractures occur among people younger than 40 years old, particularly men. For example, in Germany in 1995, 10% of all persons suffering a hip fracture were men younger than 40 years old.
We analyzed the trend of hip fracture incidence in Germany using the national register of hospital discharges from 1995 to 2004. The register has been proven for completeness and validity.7 We standardized incidences to the 2000 German population and estimated age- and gender-adjusted incidence rate ratios (IRRs) using multiple Poisson regression with correction for overdispersion. Overall, hip fracture incidence increased slightly but was statistically significant (IRR=1.05; 95% confidence interval=1.02, 1.07). The trend in adults younger than 40 years old was striking. The incidence of hip fractures (per 100000 person years, corrected for recurrent admissions) declined from 8.5 in 1995 to 6.1 in 2004 among men, and from 3.8 to 2.2 among women. The IRRs are shown in the Table 1
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There are several explanations for the declines in incidence. In Germany, as well as in several other industrialized countries, the number of work-related accidents has declined continuously.8 The proportion of manual laborers has decreased, and safety programs have improved. Additionally, the number of traffic accidents with severe injury has decreased,8 owing to improved safety features in cars (e.g., airbags, safety belts) that may have contributed to the prevention of severe fractures when accidents occur. Data from the Centers for Disease Control and Prevention indicate a decline of injury-related hospitalizations in the United States during the past decades, in particular in younger age groups.5,9 A shift from in-patient care to ambulatory care has been discussed as one possible reason for such a decline; however, hip fracture treatment generally requires hospital admission. Thus, the decrease in hip fracture-related hospitalization is likely to reflect a real decrease in hip fracture events.
Future epidemiological studies should carefully monitor hip fracture incidence trends in all age groups. Research is needed to clarify the reasons for the hip fracture decline in younger age groups.
Acknowledgments
The study was supported by a grant from the North-Rhine Westphalian Ministry of Labor, Health, and Welfare. (grant 24.59-15).
We thank Olaf Schoffer, Forschungsanstalt des Statistischen Bundesamtes, the committee of health counseling ot the North-Rhine Wesphalian Chamber of Physicians (head: Arnold Schüller), and Clemens Becker, Robert-Bosch-Krankenhaus Stuttgart, for their support in data assessment. We also thank Manfred Wildner, University of Munich, and Ulrich Dauer, Marienhospital Düsseldorf, for their support in interpreting the results.
Footnotes
Contributors
A. Icks conceptualized the study and its design, interpreted the findings, and wrote the letter. B. Haastert conducted the statistical analysis and provided assistance in the study design and interpretation of the findings. G. Meyer discussed the study conceptualization, provided assistance in the study design, provided assistance in interpreting the research findings, and reviewed the letter.
Accepted for publication April 20, 2007.
References
1. Wilson RT, Chase GA, Chrischilles EA, Wallace RB. Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. Am J Public Health. 2006;96:1210–1218.
2. Kannus P, Pakkari J, Niemi S. Age-adjusted incidence of hip fractures. Lancet. 1995;346:350–351.[CrossRef][Web of Science][Medline]
3. Centers for Disease Control and Prevention. Fatalities and injuries from falls among older adults—United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;55:1221–1222.[Medline]
4. MacKenzie E. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev. 2000;22: 112–119.
5. Shinoda-Tagawa T, Clark DE. Trends in hospitalization after injury: older women are displacing young men. Inj Prev. 2003;9:214–219.
6. Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA. 1999; 282:954–957.
7. Wildner M, Clark DE. Hip fracture incidence in East and West Germany: reassessment 10 years after unification. Osteoporos Int. 2001;12:136–139.[CrossRef][Web of Science][Medline]
8. Robert Koch Institute (RKI). Health Report of Germany. Berlin: RKI; 2006.
9. Centers for Disease Control and Prevention. National trends in injury hospitalizations, 1979–2001. National Hospital Discharge Survey, 2006. Available at: http://www.cdc.gov. Accessed March 23, 2007.
This article has been cited by other articles:
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  R. T. Wilson and R. B. Wallace TRENDS IN HIP FRACTURE INCIDENCE IN YOUNG AND OLDER ADULTS Am J Public Health, October 1, 2007; 97(10): 1734 - 1735. [Full Text] [PDF]
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