2002年至2012年加拿大安大略省所有长期护理机构和社区居住老年人骨折发生率的比较趋势。
Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012.
作者信息
Papaioannou A, Kennedy C C, Ioannidis G, Cameron C, Croxford R, Adachi J D, Mursleen S, Jaglal S
机构信息
GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
出版信息
Osteoporos Int. 2016 Mar;27(3):887-897. doi: 10.1007/s00198-015-3477-3. Epub 2016 Jan 22.
SUMMARY
In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women.
INTRODUCTION
This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012.
METHODS
This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC).
RESULTS
Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community.
CONCLUSION
Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.
摘要
在这项基于人群的研究中，我们比较了2002年至2012年期间长期护理机构（LTC）与社区老年人的骨折发生率。LTC中髋部骨折率的下降速度比社区更快。男性的髋部、骨盆和肱骨骨折以及女性仅髋部骨折在LTC中出现了额外的骨折负担。
引言
本研究比较了2002 - 2012年期间长期护理机构（LTC）与65岁及以上社区居住老年人的骨折发生率趋势。
方法
这是一项基于人群的队列研究，使用行政数据。测量指标为年龄/性别调整后的骨折发生率、率比（RR）和年度百分比变化（APC）。
结果
在11年期间，髋部骨折率显著下降，LTC中的下降速度更快（APC为 -3.49（95%置信区间（CI），-3.97，-3.01）），而社区中的下降速度为（APC为 -2.93（95%CI，-3.28，-2.57）；斜率差异p < 0.05）。肱骨和腕部骨折率下降；然而，骨盆和脊柱骨折出现了相反的趋势，两个队列中的发生率均随时间增加（所有APC，p < 0.05）。2012年，LTC中的髋部骨折发生率高于社区（RRs：女性为1.55（95%CI，1.45，1.67）；男性为2.18（95%CI，1.93，2.47））。LTC中的男性骨盆骨折（RR为1.48（95%CI，1.22，1.80））和肱骨骨折（RR为1.40（95%CI，1.07，1.84））发生率较高，女性则不然。在女性中，LTC中的腕部骨折（RR为0.76（95%CI，0.71，0.81））和脊柱骨折（RR为0.52（95%CI，0.45，0.61））发生率低于社区；在男性中，LTC中的脊柱骨折（RR为0.75（95%CI，0.57，0.98））但腕部骨折（RR为0.91（95%CI，0.67，1.23））发生率显著低于社区。
结论
先前在社区中的研究表明髋部骨折率随时间下降，本研究也证实了这一点，但LTC中的下降速度更快。肱骨和腕部骨折率也下降了。LTC中女性的髋部骨折以及男性的髋部、骨盆和肱骨骨折出现了额外的骨折负担。
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