International variation in the incidence of hip fractures

Cross-national project on osteoporosis for the World Health Organization program for research on aging

A. V. Schwartz, J. L. Kelsey, S. Maggi, M. Tuttleman, S. C. Ho, P. V. Jónsson, G. Poór, J. A Sisson De Castro, L. Xu, C. C. Matkin, L. M. Nelson, S. P. Heyse

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

A cross-national study of hip fracture incidence was carried out in five geographic areas - Beijing, China; Budapest, Hungary; Hong Kong; Porto Alegre, Brazil; and Reykjavik, Iceland - during the years 1990-1992. Cases of hip fracture among women and men of age 20 years and older were identified using hospital discharge data in conjunction with medical records, operating room logs, and radiology logs. Estimated incidence rates varied widely, with Beijing reporting the lowest rates (age-adjusted rate per 100,000 population for men 20 years and older = 45.4; women = 39.6) and Reykjavik the highest rates (men = 141.3; women = 274.1). Rates were higher for women than for men in every area except Beijing. In every area except Budapest, review of the operating room or radiology logs identified additional cases that were not reported in the discharge list, increasing the estimated number of hip fractures by 11% to 62%, depending on the area. Review of medical records identified miscoding of hip fractures (ICD9 820) as 'shaft of femur and other femur fractures' (ICD9 821) in the discharge lists of every area except Budapest, increasing the estimated number of hip fractures by 1% to 30%. The final estimates of hip fracture incidence taking into account all investigated sources of undercount and overcount ranged from 15% lower to 89% higher than an estimate based on the discharge diagnoses alone. Although these results indicate substantial limitations in relying on hospital discharge data alone to estimate hip fracture incidence rates, the extent of errors found in the discharge lists is smaller than the large international variation found here and previously reported in incidence rates. The findings support the conclusion that the differences reported among countries mainly reflect genuine variation in the hip fracture incidence rates.

Original languageEnglish
Pages (from-to)242-253
Number of pages12
JournalOsteoporosis International
Volume9
Issue number3
DOIs
Publication statusPublished - 1999

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Hip Fractures
Osteoporosis
Incidence
Research
Operating Rooms
Radiology
Femur
Medical Records
Iceland
Hungary
Hong Kong
Brazil
China
Population

Keywords

  • Hip fracture
  • Hospital discharge data
  • Incidence rates
  • International comparison
  • Osteoporosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

International variation in the incidence of hip fractures : Cross-national project on osteoporosis for the World Health Organization program for research on aging. / Schwartz, A. V.; Kelsey, J. L.; Maggi, S.; Tuttleman, M.; Ho, S. C.; Jónsson, P. V.; Poór, G.; De Castro, J. A Sisson; Xu, L.; Matkin, C. C.; Nelson, L. M.; Heyse, S. P.

In: Osteoporosis International, Vol. 9, No. 3, 1999, p. 242-253.

Research output: Contribution to journalArticle

Schwartz, AV, Kelsey, JL, Maggi, S, Tuttleman, M, Ho, SC, Jónsson, PV, Poór, G, De Castro, JAS, Xu, L, Matkin, CC, Nelson, LM & Heyse, SP 1999, 'International variation in the incidence of hip fractures: Cross-national project on osteoporosis for the World Health Organization program for research on aging', Osteoporosis International, vol. 9, no. 3, pp. 242-253. https://doi.org/10.1007/s001980050144
Schwartz, A. V. ; Kelsey, J. L. ; Maggi, S. ; Tuttleman, M. ; Ho, S. C. ; Jónsson, P. V. ; Poór, G. ; De Castro, J. A Sisson ; Xu, L. ; Matkin, C. C. ; Nelson, L. M. ; Heyse, S. P. / International variation in the incidence of hip fractures : Cross-national project on osteoporosis for the World Health Organization program for research on aging. In: Osteoporosis International. 1999 ; Vol. 9, No. 3. pp. 242-253.
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