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Gutwerk A, Müller M, Crönlein M, Kirchhoff C, Biberthaler P, Pförringer D, Braun K. [Analysis of rising treatment cost of elevated BMI in patients with proximal femoral fracture]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:449-455. [PMID: 35925229 DOI: 10.1007/s00113-022-01187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/01/2023]
Abstract
Driven by the aging population, the proximal femoral fracture is a rising fracture entity, challenging trauma surgeons as well as the German healthcare system as a whole. The rising average age of the population is accompanied by a rising BMI in the German population, resulting in longer operation times, longer average length of stay (ALOS) as well as more postoperative complications.The aim of this study was to demonstrate the economic correlation between body mass index and hospital costs. The retrospective analysis of 950 patient cases suffering from a proximal femoral fracture resulted in the finding of rising treatment costs being positively associated with rising BMI due to longer operation times and longer length of hospitalization (10,452 €, 11,505 €, 12,085 € and 13,681 € for patients with BMI < 18.5 kg/m2, BMI = 18.5-24.9 kg/m2, BMI = 25.0-29.9 kg/m2 and BMI ≥ 30.0 kg/m2, respectively).
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Affiliation(s)
- Alexander Gutwerk
- Klinik für Orthopädie, Unfall‑, Hand- und Plastische Chirurgie, DIAKO Krankenhaus, Knuthstr. 1, 24939, Flensburg, Deutschland.
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Michael Müller
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Moritz Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Chlodwig Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Karl Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Müller M, Gutwerk A, Greve F, Völker L, Zyskowski M, Kirchhoff C, Biberthaler P, Pförringer D, Braun K. The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures. J Clin Med 2020; 9:E2076. [PMID: 32630619 PMCID: PMC7408724 DOI: 10.3390/jcm9072076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. METHODS In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient's ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO's BMI groups. RESULTS The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 ± 4.8 days), normal (13.6 ± 7.8 days), overweight (14.2 ± 11.7 days), and obese patients (16.0 ± 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 ± 42.9 min; normal weight = 90.2 ± 38.2 min; overweight = 99.9 ± 39.9 min; obese = 117.2 ± 61.5 min (p < 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5-30 kg/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient's ability to walk on crutches. CONCLUSION Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function.
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Affiliation(s)
- Michael Müller
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Alexander Gutwerk
- Orthopädie, Sport- & Unfallklinik, Ev.-Luth. Diakonissenanstalt, 24939 Flensburg, Germany;
| | - Frederik Greve
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Lisa Völker
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Michael Zyskowski
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Chlodwig Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
| | - Karl Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany; (F.G.); (L.V.); (M.Z.); (C.K.); (P.B.); (D.P.); (K.B.)
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
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Saul D, Riekenberg J, Ammon JC, Hoffmann DB, Sehmisch S. Hip Fractures: Therapy, Timing, and Complication Spectrum. Orthop Surg 2019; 11:994-1002. [PMID: 31568676 PMCID: PMC6904609 DOI: 10.1111/os.12524] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Investigation of the treatment of femur fractures and the type of femur fracture‐associated complications regarding timing of surgery and length of hospital stay. Methods In this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay. Results Among the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.). In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6–24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow‐up was restrained to ambulatory visits in the clinic. Conclusions Surgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.
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Affiliation(s)
- Dominik Saul
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Juliane Riekenberg
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jan C Ammon
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel B Hoffmann
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
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Incidence Rates of and Mortality after Hip Fracture among German Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020289. [PMID: 29414914 PMCID: PMC5858358 DOI: 10.3390/ijerph15020289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022]
Abstract
Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly admitted to German nursing homes between 2010 and 2014 were used to calculate age-, sex-, care-need- and time after admission-specific IR. To determine mortality, the Kaplan-Meier-method was applied. Using Cox regression, we studied mortality and estimated time-dependent hazard ratios (HRs). For this purpose, to each person with a hip fracture, one resident without a hip fracture was matched by sex, age and care-need using risk-set sampling. 75% were women (mean age: 84.0 years). During 168,588 person-years (PY), 8537 residents with at least one hip fracture were observed. The IR for women and men were 52.9 and 42.5/1000 PY. For both sexes, IR increased with rising age and decreased with increasing care-level. IR were highest in the first months after admission and subsequently declined afterwards. The impact of hip fractures on mortality was time-dependent. Mortality of residents with hip fracture was highest in the first two months after fracture compared to those without (HR): 2.82; 95% CI 2.57–3.11) and after six months, no differences were found (HR: 1.10; 95% CI 0.98–1.22) Further research should always include analyses stratified by sex, age and time period after admission.
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Caillet P, Oberlin P, Monnet E, Guillon-Grammatico L, Métral P, Belhassen M, Denier P, Banaei-Bouchareb L, Viprey M, Biau D, Schott AM. Algorithmes d’identification des séjours pour fracture du col du fémur d’origine ostéoporotique dans les bases médico-administratives européennes utilisant la CIM-10 : revue non systématique de la littérature. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Büchele G, Becker C, Cameron ID, Auer R, Rothenbacher D, König HH, Rapp K. Fracture risk in people with developmental disabilities: results of a large claims data analysis. Osteoporos Int 2017; 28:369-375. [PMID: 27553444 DOI: 10.1007/s00198-016-3733-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Age- and sex-specific fracture rates of 18,000 people with developmental disabilities aged 0-69 years were compared to the general population. Age-standardized incidence of femoral fracture was 4.8- and 7.1-fold higher in women and men, respectively. Comparable fracture risks to the general population occurred 10-15 years earlier in females and 20-40 years earlier in males. INTRODUCTION Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types. METHODS People with DD and incident fractures were identified by routine data of a health insurance company. Fractures in the general population were derived from the official fracture statistics. Age-specific and age-standardized fracture incidences were analyzed. To compare fracture risks in people with DD with that of the general population incidence ratios were calculated. RESULTS Between 2008 and 2010, 148 femoral fractures and 469 other fractures were observed in nearly 18,000 people with DD aged 0-69 years. The three most frequent fracture types leading to hospital admission were fractures of the femur, lower leg/ankle, and shoulder/arm. For femoral fractures, a particularly high risk was observed in children and adolescents with DD. In adults with DD, the risk of femoral fractures increased with increasing age. Even if the youngest age category was not considered, the age-standardized incidence was 4.8- and 7.1-fold higher in women and men, respectively. For all other fracture types, except fractures of forearm/hand and of pelvis, people with DD had also higher fracture incidences than the general population. CONCLUSIONS People with DD have a high fracture burden. Comparable risks of femoral fracture, for example, occurred about 10-15 years earlier in females and even 20-40 years earlier in males with DD than in the general population.
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Affiliation(s)
- G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - C Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, St Leonards, NSW 2065, Australia
| | - R Auer
- Department of care management, AOK Baden-Württemberg, Presselstr. 19, 70191, Stuttgart, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - H H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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Defèr A, Schober HC, Möhrke W, Abendroth K, Hofbauer LC. Are there still east-to-west differences in the incidence of hip fractures in Germany? Arch Osteoporos 2014; 9:195. [PMID: 25322672 DOI: 10.1007/s11657-014-0195-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 09/10/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population, and only to a small extent by the regulation of specific medication. INTRODUCTION The most important complications and the major cost factors of osteoporosis are fractures. In order to develop strategies for fracture prevention, knowledge about different incidence rates and possible causes is necessary. METHODS In order to detect persistent differences in the incidence of hip fractures between the former eastern and western states of Germany, structured diagnostic data of patients hospitalized between 2000 and 2011 were used to determine the regional incidence of hip fractures in the individual federal states of Germany. To account for error due to repeated admissions and double registrations, the frequency of fractures was corrected by a factor of 0.89. RESULTS Our analysis of the 10-year period from 2000 to 2011 did not confirm the difference between eastern and western Germany reported in the national literature, or the north-south gradient for Germany as reported in several European publications. We found significant differences in the incidence of fractures in adjacent territorial states such as Schleswig-Holstein and Mecklenburg-Western Pomerania or Saxony and Thuringia. Particularly, high incidence rates over the entire period were noted in the city-states of Hamburg, Berlin, and Bremen. CONCLUSION The reason for such differences is still unclear and, thus, the consequences of urbanization must be considered to explain diverse incidence rates. In general, the investigation of causes should be based on the use of a multivariate model that takes additional factors such as specific drug use, socioeconomic aspects, environmental aspects, education, and health care into account. There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population and only to a small extent by the regulation of specific medication.
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Affiliation(s)
- Alexander Defèr
- Medical Office, Großenhainer Strasse 129, 01129, Dresden, Germany,
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Icks A, Arend W, Becker C, Rapp K, Jungbluth P, Haastert B. Incidence of hip fractures in Germany, 1995-2010. Arch Osteoporos 2013; 8:140. [PMID: 23674147 DOI: 10.1007/s11657-013-0140-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/23/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed hip fracture incidence trends in Germany in 1995-2010, using national hospital discharge register. Overall, after age-sex-region adjustment, there was no significant trend. However, stratified analyses showed a significant decrease in younger people. In the elderly, there was a moderate increase in men and decrease in women. Incidences were still higher in Western Germany (each significant). BACKGROUND Whereas most studies from US and European countries found trends of a decreasing hip fracture incidence in the last years, in Germany, an increase has been still observed up to 2003. METHODS Analysis of annual hip fracture incidences in Germany was carried out using the national hospital discharge register and a correction factor of 0.89. Estimate of age-sex-adjusted changes was determined using the Poisson regression (incidence rate ratios, IRR; with 95 % confidence intervals, CI), overall and in age-sex-region strata. RESULTS The number of patients with at least one hospital admission for hip fracture increased (1995: n = 99,146; 2010: n = 128,240). Overall, after adjustment for age, sex, and region, there was no significant trend during the observation period. However, in stratified analyses, a significant decrease was seen in people aged less than 40 years in both sexes and regions. Also, in women aged 60 years or older, the incidence decreased (Western Germany p = 0.001) or remained (Eastern Germany p = 0.053) (IRR 1995-2010, 95 % CI: 0.95, 0.92-0.98; and 1.05, 0.999-1.11). In contrast, the incidence in men 40-59 and 60 years older increased in both regions (West: 1.03, 0.97-1.09; and 1.11, 1.07-1.14; East: 1.12, 1.01-1.25; and 1.29, 1.22-1.36). While incidences were still significantly higher in Western Germany overall and in most strata, they tended to converge. CONCLUSIONS In line with most European countries, the overall hip fracture incidence in Germany no longer increases. However, differences between age, sex, and region exist.
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Affiliation(s)
- Andrea Icks
- Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstr. 59, 40225 Düsseldorf, Germany.
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Gauthier A, Kanis JA, Jiang Y, Dreinhöfer K, Martin M, Compston J, Borgström F, Cooper C, McCloskey E. Burden of postmenopausal osteoporosis in Germany: estimations from a disease model. Arch Osteoporos 2012. [PMID: 23196864 DOI: 10.1007/s11657-012-0099-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This article describes the adaptation of a model assessing the incidence of osteoporotic fractures and prevalence of postmenopausal osteoporosis (PMO) in Germany. PURPOSE The purpose of this paper is to estimate the epidemiological burden of PMO in Germany from 2010 to 2020. METHODS For each year of the study, the 'incident cohort' (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures (1, 2 or ≥3) and deaths. Although the fracture site was not explicitly accounted for in the model structure, the site (hip, vertebral, non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected the site-specific risk of death and of subsequent fractures. Model inputs included population size and life tables from 1970 to 2020, incidence of fracture and BMD by age in the general population (mean and standard deviation). RESULTS In 2010, the number of osteoporotic fractures was estimated at 349,560 in women aged 50 years or more, including 80,177 hip and 48,550 vertebral fractures. By 2020, the population is expected to grow by 13.1 %. As a result, the number of fractures is predicted to increase by 15.2 %. The improvement in life expectancy is predicted to lead to a relatively smaller increase in the number of deaths attributable to fractures (+12.8 %), but also to an increase in the prevalence of women with multiple prior fractures (+25.5 %). CONCLUSION The PMO disease model, first developed for Sweden, was adapted to Germany. Due to the ageing of the population, the number of osteoporotic fractures is expected to increase markedly by +15.2 % by 2020.
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Icks A, Haastert B, Glaeske G, Stumpf U, Windolf J, Hoffmann F. Correction factor for the analysis of the hip fracture incidence—differences between age, sex, region, and calendar year. Wien Klin Wochenschr 2012; 124:391-4. [DOI: 10.1007/s00508-012-0188-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
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Augustin M, Glaeske G, Schäfer I, Rustenbach SJ, Hoer A, Radtke MA. Processes of psoriasis health care in Germany--long-term analysis of data from the statutory health insurances. J Dtsch Dermatol Ges 2012; 10:648-55. [PMID: 22525221 DOI: 10.1111/j.1610-0387.2012.07893.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate health care provision for psoriasis patients, and to better allocate resources, precise knowledge of the health care situation is essential. The goal of this study is to analyze prescription behavior and resource utilization for psoriasis patients in Germany. METHODS We performed a secondary analysis of routinely collected psoriasis data from 2004-2007 from members of a nationwide statutory health insurance company (Gmünder Ersatzkasse). A descriptive analysis was done on physician care, hospitalizations, and medications and related costs. RESULTS 34,728 of the 913,145 continuously insured patients were diagnosed with psoriasis (one-year prevalence: 2.3-2.5%). At the time of the initial diagnosis, 68% of patients were treated by a dermatologist and 28% by a general practitioner (GP). Over the next 21 months, the proportion of patients seen by a dermatologist decreased to 22% and the proportion seen by a GP increased to around 70%. 15.2% of patients were absent at least once from work. 79.5% received prescriptions with an average cost of € 135 per patient per year. 97.5% of patients received topical therapy; 11% got systemic therapies. Biologics were given to about 0.1% of patients. Significant differences in prescription behavior were seen between regions and physician groups. CONCLUSION Psoriasis is an important economic and medical issue. The majority of insured patients take prescription therapies. Dermatologists are most often the first health care provider.
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Affiliation(s)
- Matthias Augustin
- CVderm - Competence Center for Health Care Research in Dermatology, University Hospital of Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
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Discrepancies in national incidence trends for hip fracture: why does Austria have such a high incidence? Wien Klin Wochenschr 2010; 122:126-8. [PMID: 20361373 DOI: 10.1007/s00508-010-1321-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mann E, Meyer G, Haastert B, Icks A. Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study. BMC Public Health 2010; 10:46. [PMID: 20113471 PMCID: PMC2831031 DOI: 10.1186/1471-2458-10-46] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/29/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies evaluated variations in hip fracture incidences, as well as trends of the hip fracture incidences. Comparisons of trends are lacking so far. We compared the incidence rates and, in particular, its trends between Austria and Germany 1995 to 2004 analysing national hospital discharge diagnosis register data. METHODS Annual frequencies of hip fractures and corresponding incidences per 100,000 person years were estimated, overall and stratified for sex and age, assuming Poisson distribution. Multiple Poisson regression models including country and calendar year, age and sex were used to analyse differences in incidence and trend. The difference of annual changes between the two countries was explored using an interaction term (calender year * country). RESULTS Overall, the increase of hip fracture risk was 1.31 fold higher (95% CI 1.29-1.34) in Austria compared to Germany, adjusted for age, sex, and calendar year. The risk increase was comparable for both sexes (males: RR 1.35 (1.32-1.37), females: RR 1.31 (1.29-1.33)). Hip fracture trend from 1995 to 2004 indicates an increase in both countries without a statistically significant difference between Austria and Germany (interaction term: p = 0.67). CONCLUSION In this study comparing hip fracture incidences and its trend using pooled data, the incidence in Austria was 30% higher compared to its neighbouring country Germany. For both countries a similar increasing trend of hip fracture incidence over the 10-year study period was calculated. The results need confirmation by other studies.
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Affiliation(s)
- Eva Mann
- General Practice and Institute for Health Services Research, Rankweil, Austria
| | - Gabriele Meyer
- Faculty of Medicine, Institute of Nursing Science, Witten/Herdecke University, Witten, Germany
| | | | - Andrea Icks
- Faculty of Public Health, Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany; and North-Rhine Westfalian Chamber of Physicians, Düsseldorf, Germany
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Icks A, Haastert B, Wildner M, Becker C, Rapp K, Dragano N, Meyer G, Rosenbauer J. Hip fractures and area level socioeconomic conditions: a population-based study. BMC Public Health 2009; 9:114. [PMID: 19397798 PMCID: PMC2685377 DOI: 10.1186/1471-2458-9-114] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 04/27/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Only a limited number of studies have analyzed the association between hip fracture incidence and socioeconomic conditions. Most, but not all found an association, and results are in part conflicting. The aim of our study was to evaluate the association between hip fractures and socioeconomic conditions in Germany, from 1995 to 2004, on a census tract area level. METHODS We used data from the national hospital discharge diagnosis register and data on socioeconomic and demographic characteristics of 131 census tracts from official statistics. Associations between the hip fracture incidence and socioeconomic conditions were analyzed by multiple Poisson regression models, taking overdispersion into account. RESULTS The risk of hip fracture decreased by 4% with a 7% increase (about one interquartile range) of non-German nationals. It decreased by 10% with a 6% increased rate of unemployment, increased by 7% with a 2% increase of the proportion of welfare recipients, and also increased by 3% with an increase of the proportion of single parent families of 1.9%. CONCLUSION Our results showed weak associations between indicators of socioeconomic conditions at area level and hip fracture risk; the varied by type of indicator. We conclude that hip fracture incidence might be influenced by the socioeconomic context of a region, but further analysis using more specific markers for deprivation on a smaller scale and individual-level data are needed.
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Affiliation(s)
- Andrea Icks
- Faculty of Public Health, Bielefeld University, Germany
- North-Rhine Westphalian Chamber of Physicians, Düsseldorf, Germany
| | | | - Manfred Wildner
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Gabriele Meyer
- Institute of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Joachim Rosenbauer
- Institute of Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
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Gandjour A, Weyler EJ. Cost-effectiveness of preventing hip fractures by hip protectors in elderly institutionalized residents in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:1088-1095. [PMID: 19602215 DOI: 10.1111/j.1524-4733.2008.00393.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the long-term cost-effectiveness of hip protector use in the prevention of hip fractures in elderly institutionalized residents in Germany compared to no prevention. METHODS A lifetime Markov decision model was developed using published data on costs and health outcomes. A societal and statutory health insurance perspective was adopted. RESULTS From a societal/statutory health insurance perspective, use of hip protectors yields savings of 315 EURO/257 EURO and a gain of 0.13 quality-adjusted life years per person over lifetime. CONCLUSION Hip protector use in elderly institutionalized residents in Germany is highly cost-effective.
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Affiliation(s)
- Afschin Gandjour
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
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Abstract
It is assumed that nursing homes are the setting with the highest incidence of hip fractures. This observation is, however, based on very little data. The aim of this study was to analyze hip fracture rates and the associated excess mortality in a large nursing home population. A cohort of >69,000 women and men newly admitted to German nursing homes were used to calculate sex- and age-specific incidence rates of hip fractures. To calculate excess mortality, a retrospective cohort study was conducted. To each patient with a hip fracture (n = 4342), four residents without hip fracture (n = 17,368) were matched by sex, age, and level of care (measure for the need of care). Hazard regression models were applied. During 91,850 person-years, 4342 hip fractures were observed. The crude incidence rates for hip fractures were 50.8/1000 person-years in women and 32.7/1000 person-years in men. The incidence rates increased with increasing age categories and were highest in the first months after admission to the nursing home. Increasing care need reduced the risk of hip fracture. Mortality in patients with a hip fracture was increased (women: hazard rate ratio for the first 3 mo after fracture, 1.72; 95% CI, 1.59-1.86; men: hazard ratio, 2.14; 95% CI, 1.80-2.53), but excess mortality was limited to the first months after injury. Data are presented for hip fracture rates and excess mortality after a hip fracture. Our results have implications on the timing and the allocation of specific measures for hip fracture prevention.
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Icks A, Haastert B, Wildner M, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: a population-based study. Osteoporos Int 2008; 19:1139-45. [PMID: 18087659 DOI: 10.1007/s00198-007-0534-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED We analyzed hip fracture incidence trends in Germany 1995-2004, using national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p<0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. INTRODUCTION Data concerning actual trends of the hip fracture incidence and differences for sex, age, and region are limited. We analyzed hip fracture incidence trends in Germany 1995-2004, using the national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p<0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. METHODS Analysis of annual hip fracture incidences using the national hospital discharge register. Estimate of age-sex-adjusted changes was found by using Poisson regression (incidence rate ratios, IRR). RESULTS The number of patients with at least one hospital admission for hip fracture increased (1995: n=99,141; 2004: n=116,281). Crude incidences per 100,000 were 121.2 (95% confidence interval 120.5-121,9) and 140.9 (140.2-141.7), respectively. The age-sex-adjusted hip fracture incidence increased statistically significantly, but only slightly (IRR per year: 1.01; 1.00-1.01; IRR 1995-2004: 1.05, p<0.01). In men aged 40 years or older, incidences increased. In women, there was a tendency of a decrease up to 74 years of age, but also a significant increase in higher age groups. In people 0-39 years, the incidence declined markedly (IRR 1995-2004, men 0.74; 0.69-0.79, women 0.62; 0.55-0.69, both p<0.01). The increase was significantly higher in Eastern compared to Western Germany (interaction: p=0.002), and differences between East and West decreased. CONCLUSIONS In contrast to earlier years, the hip fracture incidence in Germany 1995-2004 increased only slightly, with a decline in younger people, but increases in older ages, particularly in men. Regional differences decreased.
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Affiliation(s)
- A Icks
- Faculty of Public Health, Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
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