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The Association of Race, Gender, and Comorbidity With Mortality and Function After Hip Fracture

¹ Program of Research in Serious Physical and Mental Illness & Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.
² Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York.
³ Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore.
⁴ Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York.
⁵ Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
⁶ Trauma Service, New York University Hospital for Joint Diseases, New York, New York.

Address correspondence to Joan D. Penrod, PhD, GRECC/TREP, James J. Peters VA Medical Center, 130 Kingsbridge Road, Bronx, NY 10468. E-mail: joan.penrod{at}mssm.edu

Background. Few studies of hip fracture have large enough samples of men, minorities, and persons with specific comorbidities to examine differences in their mortality and functional outcomes. To address this problem, we combined three cohorts of hip fracture patients to produce a sample of 2692 patients followed for 6 months.

Method. Data on mortality, mobility, and other activities of daily living (ADLs) were available from all three cohorts. We used multiple regression to examine the association of race, gender, and comorbidity with 6-month survival and function, controlling for prefracture mobility and ADLs, age, fracture type, cohort, and admission year.

Results. The mortality rate at 6 months was 12%: 9% for women and 19% for men. Whites and women were more likely than were nonwhites and men to survive to 6 months, after adjusting for age, comorbidities, and prefracture mobility and function. Whites were more likely than were nonwhites to walk independently or with help at 6 months compared to not walking, after adjusting for age, comorbidities, and prefracture mobility and function. Dementia had a negative impact on survival, mobility, and ADLs at 6 months. The odds of survival to 6 months were significantly lower for people with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and/or cancer. Parkinson's disease and stroke had negative impacts on mobility and ADLs, respectively, among survivors at 6 months.

Conclusions. The finding of higher mortality and worse mobility for nonwhite patients with hip fractures highlights the need for more research on race/ethnicity disparities in hip fracture care.

Key Words: Hip fracture • Mobility • Activities of daily living • Mortality