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Surís X, Rodríguez C, Llargués E, Pueyo-Sánchez MJ, Larrosa M. Trend and Seasonality of Hip Fractures in Catalonia, Spain: Exploring the Influence of Climate. Calcif Tissue Int 2024; 114:326-339. [PMID: 38340169 PMCID: PMC10957628 DOI: 10.1007/s00223-024-01182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 02/12/2024]
Abstract
To describe the secular trend and seasonality of the incidence of hip fracture (HF) and its relationship with climatic variables during the period 2010-2019 in Catalonia in people aged ≥ 65 years. The results were analyzed by sex, age groups (65-74, 75-84, and ≥ 85), and types of fracture (extracapsular and intracapsular). Data on sex, age, type of fracture, year, and month of hospitalization of patients admitted with a diagnosis of HF between January 1, 2010 and December 31, 2019 were collected. Crude and standardized HF incidence (HFi) rates were obtained. Data on the monthly mean of climatological variables (temperature, insolation, icy days, rain, relative humidity, atmospheric pressure, and wind force) were obtained from the network of meteorological stations in Catalonia. Time series analytical statistics were used to identify trends and seasonality. Linear regression and a seasonal autoregressive integrated moving average (ARIMA) were used to analyze the relationship of each climatic parameter with fracture rates. In addition, generalized additive models were used to ascertain the best predictive model. The total number of HF episodes was 90,149 (74.1% in women and 25.9% in men). The total number of HFs increased by 6.4% between 2010 and 2019. The median age (SD) was 84.5 (7.14) and 54% of patients were ≥ 85 years of age. Extracapsular fractures were the most common (55%). The standardized incidence rates decreased from 728.1/100,000 (95% CI 738.6-769.3) to 624.5/100,000 (95% CI 648.7-677.0), which represents a decrease of 14.2% (p < 0.05). The decline was greater at older ages. There were seasonal variations, with higher incidences in autumn (27.2%) and winter (25.7%) and lower rates in summer (23.5%) and spring (23.6%). Seasonality was more pronounced in elderly people and men. In the bivariate regression analysis, high temperatures and greater insolation were negatively associated with the HF rate, while the number of icy days, rainy days, and high relative humidity were associated with a higher incidence of fractures in all age groups and sexes. In the regression analysis using the seasonal ARIMA model, only insolation had a consistently significant association with overall HFi, after adjusting by trend and other climatic parameters. While the global number of HFs grew in Catalonia due to increases in the elderly population, the standardized HF rate decreased during the years 2010-2019. There was a seasonal trend, with predominance in the cold months and correlations with climatic parameters, especially with insolation.
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Affiliation(s)
- Xavier Surís
- Master Plan of Musculoskeletal Diseases, Department of Health, C/Travessera de les Corts, 131-159, 08028, Barcelona, Catalonia, Spain.
- Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.
| | - Clara Rodríguez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
- Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Maria J Pueyo-Sánchez
- Assistance and Participation Area. La Unió, Association of Health and Social Entities, Barcelona, Spain
| | - Marta Larrosa
- Master Plan of Musculoskeletal Diseases, Department of Health, C/Travessera de les Corts, 131-159, 08028, Barcelona, Catalonia, Spain
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Rau Y, Amtsfeld J, Reimers N, Matrisch L, Frese J, Schulz AP. The development, incidence and treatment trends of trochanteric fractures in Germany: a cohort study. J Orthop Surg Res 2023; 18:491. [PMID: 37430277 PMCID: PMC10331963 DOI: 10.1186/s13018-023-03981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Hip fractures are a major public health problem worldwide and can lead to disability, increased mortality, and reduced quality of life. We aim to provide a nationwide epidemiological analysis of trochanteric and subtrochanteric fractures and their respective surgical treatments. METHODS Data were retrieved from the national database of the German Department of the Interior. ICD-10-GM and OPS data from the period of 2006 to 2020 were analysed and all patients with trochanteric and subtrochanteric fractures as their main diagnosis, who were treated in a German hospital, were included. Patients were grouped by age and gender and linear regression was performed where suitable to calculate statistically significant correlations between variables and incidences. RESULTS 985,104 pertrochanteric fractures and 178,810 subtrochanteric fractures were reported during the analysed period. We calculated a mean incidence of 80.08 ± 6.34 for pertrochanteric and 14.53 ± 1.50 for subtrochanteric fractures per million inhabitants. In both fracture types, a distinct dependence of incidence on age can be determined. Incidence rates equally rise in both sexes through the age groups with an increase of about 288-fold from those under the age of 60 to those over the age of 90 in pertrochanteric fractures, and about 123-fold in subtrochanteric fractures. Intramedullary nailing was the most common kind of treatment for both fracture types with augmentative cerclages on the rise throughout the whole period. Plate and dynamic compression screws were decreasing in frequency over the analysed period in both fractures. CONCLUSIONS We provided incidence data on per- and subtrochanteric fractures and their treatment. We calculated an economic impact of approximately 1.563 billion € per year in Germany. With regards to recent literature on costs of treatment and our findings regarding the implementation and utilization of different treatment methods, we conclude that the reinforcement of nationwide prevention programs is a relevant step in lessening the economic burden. We welcome the increased utilisation of intramedullary nailing as many studies show beneficiary outcomes and cost effectiveness in most of the included fracture types.
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Affiliation(s)
- Yannick Rau
- Faculty of Medicine, Universität zu Lübeck, Lübeck, Germany.
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany.
| | - Jasper Amtsfeld
- Chair of Technology Management, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Nils Reimers
- Stryker Trauma GmbH, Schoenkirchen, Germany
- Queensland University of Technology, Brisbane City, Australia
| | | | - Jasper Frese
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Arndt-Peter Schulz
- Faculty of Medicine, Universität zu Lübeck, Lübeck, Germany
- Zentrum Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
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Surís X, Vela E, Clèries M, Llargués E, Camins J, Larrosa M. Effects of COVID-19 confinement on the incidence and mortality of major osteoporotic fractures: an observational study in Catalonia, Spain. Arch Osteoporos 2022; 17:150. [PMID: 36441292 PMCID: PMC9702769 DOI: 10.1007/s11657-022-01193-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
There is little information on how the COVID-19 lockdown influenced the epidemiology of major osteoporotic fractures (MOF). We analyzed the incidence and mortality of MOF in 2020 compared with 2018-2019 in Catalonia, Spain. The incidence of MOF decreased steeply, and post-fracture mortality increased during the lockdown and throughout 2020. PURPOSE To analyze the effect of the COVID-19 pandemic and lockdown on major osteoporotic fracture (MOF) incidence and mortality in Catalonia in 2020 and describe how age, sex, and the prior comorbidity burden influenced the epidemiology of MOF types. METHODS In this retrospective observational study, data on age and sex in people aged ≥ 50 years with a new diagnosis of MOF in 2018, 2019, and 2020 were collected. Average daily rates (ADR) were estimated overall and for five MOF: hip, distal forearm, proximal humerus, vertebrae, and pelvis. Morbidity was assessed using Adjusted Morbidity Groups. ADR in 2020 and the previous years were compared for overall and site-specific MOF in four consecutive time periods: pre-confinement, lockdown, deconfinement, and post-confinement. Thirty-day post-fracture mortality was assessed. COVID-19-related mortality was obtained from the Catalan COVID-19 register. RESULTS From 2018 to 2020, there were 86,412 MOF. The ADR of MOF initially increased in 2020 before the pandemic, decreased steeply during lockdown, and remained lower in the rest of the year. The decrease was steeper in vertebral, pelvic and arm fractures, and lower in hip fractures. Differences were more pronounced in younger age groups and people with fewer comorbidities. Mortality increased throughout 2020, reaching a 2.5-fold increase during lockdown. Excess mortality was directly associated with COVID-19. CONCLUSIONS Mobility restrictions due to COVID-19 were associated with a reduction in MOF incidence in Catalonia, especially in younger people and in non-hip fractures. Post-fracture mortality was higher than in previous years due to the high COVID-19 mortality in the elderly.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain.
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain.
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
- Catalan Health Service, Barcelona, Spain.
| | - Emili Vela
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Montserrat Clèries
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Jordi Camins
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
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da Silva ARB, Martinez LC, de Medeiros Pinheiro M, Szejnfeld VL. Secular trends in hip fractures in adults over 50 years old: a retrospective analysis of hospital admissions to the Brazilian Public Health System from 2004 to 2013. Arch Osteoporos 2022; 17:50. [PMID: 35304665 DOI: 10.1007/s11657-022-01092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration. PURPOSE Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions. METHODS This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends. RESULTS The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions. CONCLUSION Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.
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Affiliation(s)
- Alex Rocha Bernardes da Silva
- Rheumatology Division, Federal University of Sao Paulo/Paulista School of Medicine (Unifesp/EPM), São Paulo, Brazil.
| | - Laura Christina Martinez
- Rheumatology Division, Federal University of Sao Paulo/Paulista School of Medicine (Unifesp/EPM), São Paulo, Brazil
| | - Marcelo de Medeiros Pinheiro
- Rheumatology Division, Federal University of Sao Paulo/Paulista School of Medicine (Unifesp/EPM), São Paulo, Brazil
| | - Vera Lúcia Szejnfeld
- Rheumatology Division, Federal University of Sao Paulo/Paulista School of Medicine (Unifesp/EPM), São Paulo, Brazil
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Surís X, Vela E, Clèries M, Pueyo-Sánchez MJ, Llargués E, Larrosa M. Epidemiology of major osteoporotic fractures: a population-based analysis in Catalonia, Spain. Arch Osteoporos 2022; 17:47. [PMID: 35267128 DOI: 10.1007/s11657-022-01081-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to estimate the incidence of major osteoporotic fractures in Catalonia, Spain, in 2018 and 2019 and their association with age, sex, income, climate and a set of comorbidities. METHODS Data on age, sex, smoking, alcohol abuse, comorbidities (obesity, Parkinson's disease, arthritis, chronic kidney disease, hepatic cirrhosis, diabetes, chronic obstructive pulmonary disease, dementia, cerebrovascular disease, hyperthyroidism, multiple myeloma and epilepsy) and income levels in people aged ≥ 50 years with a new diagnosis of major osteoporotic fractures in 2018 and 2019 were collected from the Catalan Health Surveillance System (CHSS). Climatological variables were obtained from the Catalan Meteorological Service. Incidence rates were estimated for five major osteoporotic fractures (MOF). Associations between osteoporotic fractures and age, sex, income, comorbidities and climate variables were ascertained through multilevel generalized linear model analysis (Poisson's regression). RESULTS There were 60,671 MOF. The annual incidence rate per 1000 persons/years at risk (PYAR) was 10.6 (3.1 for hip, 2.3 for distal forearm, 2.2 for vertebrae, 1.7 for pelvis and 1.5 for proximal humerus). Female sex, older age, lower income, smoking, alcohol abuse and some common comorbidities were associated with a higher incidence of MOF while obesity was a protective factor. CONCLUSIONS MOF are frequent in the adult Catalan population, especially in older women and people on low incomes. Hip fracture is the most frequent, followed by forearm and vertebral fractures. Smoking, alcohol abuse and some comorbidities were associated with an increased incidence of fracture.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain. .,Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN, 08400, Granollers, Barcelona, Spain. .,School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain. .,Catalan Health Service, Catalonia, Spain.
| | - Emili Vela
- Knowledge and Information Unit, Catalan Health Service, Catalonia, Spain.,Digitalization for the Sustainability of the Healthcare System, Catalonia, Spain
| | - Montserrat Clèries
- Knowledge and Information Unit, Catalan Health Service, Catalonia, Spain.,Digitalization for the Sustainability of the Healthcare System, Catalonia, Spain
| | - Maria-Jesús Pueyo-Sánchez
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain.,Catalan Health Service, Catalonia, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.,Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
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Guañabens N, Olmos JM, Hernández JL, Cerdà D, Hidalgo Calleja C, Martinez López JA, Arboleya L, Aguilar Del Rey FJ, Martinez Pardo S, Ros Vilamajó I, Suris Armangué X, Grados D, Beltrán Audera C, Suero-Rosario E, Gómez Gracia I, Salmoral Chamizo A, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Ojeda Bruno S, García Carazo S, García Vadillo A, López Vives L, Martínez-Ferrer À, Borrell Paños H, Aguado Acín P, Castellanos-Moreira R, Tebé C, Gómez-Vaquero C. Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int 2021; 32:1333-1342. [PMID: 33459805 DOI: 10.1007/s00198-021-05824-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
UNLABELLED Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.
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Affiliation(s)
- N Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - J M Olmos
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J L Hernández
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - D Cerdà
- Department of Rheumatology, Hospital Moisès Broggi, Sant Joan Despí, University of Barcelona, Barcelona, Spain
| | - C Hidalgo Calleja
- Department of Rheumatology, University Hospital de Salamanca, Salamanca, Spain
| | - J A Martinez López
- Department of Rheumatology, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - L Arboleya
- Department of Rheumatology, University Hospital Central de Asturias, Oviedo, Spain
| | - F J Aguilar Del Rey
- Department of Rheumatology, University Hospital Virgen de la Victoria, Malaga, Spain
| | - S Martinez Pardo
- Department of Rheumatology, University Hospital Mutua Terrassa, Barcelona, Spain
| | - I Ros Vilamajó
- Department of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - X Suris Armangué
- Department of Rheumatology, Hospital General de Granollers, Granollers, International University of Catalunya, Barcelona, Spain
| | - D Grados
- Department of Rheumatology, Hospital d'Igualada, Igualada, Barcelona, Spain
| | - C Beltrán Audera
- Department of Rheumatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - E Suero-Rosario
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - I Gómez Gracia
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - A Salmoral Chamizo
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - I Martín-Esteve
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - H Florez
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Naranjo
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S Castañeda
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - S Ojeda Bruno
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S García Carazo
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - A García Vadillo
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - L López Vives
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - À Martínez-Ferrer
- Department of Rheumatology, University Hospital Doctor Peset, Valencia, Spain
| | - H Borrell Paños
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - P Aguado Acín
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - R Castellanos-Moreira
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Gómez-Vaquero
- Department of Rheumatology, University Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Lee YL, Lee HS, Tsai CF, Hsu YH, Yang HY. Secular trends of patients hospitalized for major osteoporotic fractures based on a national claims database. Arch Osteoporos 2021; 16:62. [PMID: 33825998 DOI: 10.1007/s11657-021-00935-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/30/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED There was a reduction in the hospitalization rate for major osteoporotic fractures. As per our analysis, hospitalization for site-specific fractures showed a declining trend for hip and vertebral fractures for both the sexes. However, an increasing trend was noted in women regarding hospitalization for forearm fracture. PURPOSE Major osteoporotic fractures (MOFs) constitute a large proportion of the total expenditures for public healthcare. Knowing the secular trends of MOF will allow for more efficient use of healthcare resources, but such data are insufficient for the current population of Taiwan. Therefore, we investigated the epidemiological data of MOF hospitalization from adults 50 years of age or older in Taiwan during the period 2000-2015. METHODS The data analyzed were acquired from the Taiwan National Health Insurance Research Database (NHIRD) entries between 2000 and 2015. All study subjects were 50 years of age or older at the time of admission and diagnosed as having MOF. RESULTS A general decline was observed in the incidence rate (IR) of MOF hospitalization for the whole population, from 74.52 per 10,000 person-years (PYs) in 2000 to 55.19 in 2015. Females aged ≥65 years had the highest rates of hospitalization for MOF among the subgroups analyzed. Apart from the wrist fracture hospitalization rates in both sexes, which remained steady, all other site-specific fracture hospitalization rates exponentially increased with age. Among men, the IRs of all MOF hospitalization were steady, except for a slight decrease in hip and vertebral fracture hospitalizations. In women, hip and vertebral fracture hospitalization rates gradually decreased, humerus and wrist fracture hospitalization remained steady, and forearm fracture hospitalization increased. CONCLUSIONS Hospitalization rates of MOF decreased. The trend of site-specific fracture hospitalization analysis showed that hip and vertebral fractures decreased for both sexes. However, an increasing trend in forearm fracture hospitalization was noticed among females.
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Affiliation(s)
- Yi-Lin Lee
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi, 600, Taiwan
| | - Yueh-Han Hsu
- Department of Medical Research, China Medical University Hospital and China Medical University, Taichung, 404, Taiwan
- Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, 736, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi, 600, Taiwan.
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Choi HG, Lee JK, Lee MJ, Park B, Sim S, Lee SM. Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort. Osteoporos Int 2020; 31:2345-2354. [PMID: 32632509 DOI: 10.1007/s00198-020-05475-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up. PURPOSE To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius. METHODS This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525). RESULTS The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment. CONCLUSION The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.
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Affiliation(s)
- H G Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - J K Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - M J Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
| | - B Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - S Sim
- Department of Statistics and Institute of Statistics, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea.
| | - S-M Lee
- Department of Cornea, External Disease & Refractive Surgery, HanGil Eye Hospital, Catholic Kwandong University College of Medicine, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea.
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9
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Ogliari G, Lunt E, Ong T, Marshall L, Sahota O. The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study. Arch Osteoporos 2020; 15:156. [PMID: 33026586 PMCID: PMC7539555 DOI: 10.1007/s11657-020-00825-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK.
| | - Eleanor Lunt
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lindsey Marshall
- Department of Trauma & Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Opinder Sahota
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
- University of Nottingham , Nottingham, UK
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10
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Rey-Rodriguez MM, Vazquez-Gamez MA, Giner M, Garrachón-Vallo F, Fernández-López L, Colmenero MA, Montoya-García MJ. Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain. BMJ Open 2020; 10:e037101. [PMID: 32973058 PMCID: PMC7517558 DOI: 10.1136/bmjopen-2020-037101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville). SETTING AND PARTICIPANTS This was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event. OUTCOME MEASURES We evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors. RESULTS The overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m2, renal failure and low plasma proteins. CONCLUSIONS Our results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.
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Affiliation(s)
| | - M A Vazquez-Gamez
- Medicine Department, Universidad de Sevilla Facultad de Medicina, Sevilla, Spain
| | - Mercè Giner
- Citología e Histología Normal y Patológica, Universidad de Sevilla Facultad de Medicina, Sevilla, Spain
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11
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Mazzucchelli R, Pérez Fernández E, Crespí Villarías N, Tejedor Alonso MÁ, Sáez López P, García-Vadillo A. East-west gradient in hip fracture incidence in Spain: how much can we explain by following the pattern of risk factors? Arch Osteoporos 2019; 14:115. [PMID: 31773387 DOI: 10.1007/s11657-019-0665-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/29/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our objective was to analyze the incidence and trend of hip fracture in Spain and its distribution by Autonomous Community (AC). In Spain, the age-adjusted incidence rate of hip fracture is decreasing. There is great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, and climatic factors and cohort effect factors of the civil war explain 96% of this variability. INTRODUCTION In Spain, there is great variability between the different Autonomous Communities (ACs) in the incidence of hip fracture. The objectives of our study are (1) to estimate the incidence rate and trend of hospital admissions for hip fracture in Spain and by ACs and (2) to analyze risk factors/markers that could explain the variability in the incidence and trend between different ACs. METHOD This work includes 2 studies (TREND-HIP and VAR-HIP). TREND-HIP: retrospective, national, observational study based on the administrative database of the National Health System that includes a Minimum Basic Data Set (MBDS) of hospital admissions. VAR-HIP: ecological study based on the analysis of the results obtained in TREND-HIP study, with different risk factors/markers obtained from different sources. RESULTS In the 17 years included in the analysis, there were 744,848 patients diagnosed with hip fracture. The global age-adjusted rate of hip fracture at the national level was 315.38/100,000 person*year (95% CI 312.36-317.45); by AC, the rate varied from 213.97 in the Canary Islands to 363.13 in the Valencia and Cataluña communities. We observe an east-west gradient in Spain. The trend for both sexes was - 0.67% (95% CI 0.9990-0.9957) (p < 0.001). In the analysis of risk factors/markers that explain this distribution, we found significant correlations with genetic factors, demographics, climatic factors and the time a region was on the Republican side of the civil war. The linear regression model that includes the factors that show significant correlation explains 96% of the variability observed. CONCLUSION In Spain, the age-adjusted incidence rate for hip fracture is decreasing. There is a great variability in the incidence and tendency of hip fracture among the different ACs. Genetic, demographic, climatic factors and the cohort effect of the civil war explain 96% of this variability.
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Affiliation(s)
- Ramón Mazzucchelli
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Elia Pérez Fernández
- Department of Clinical Research, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | - Pilar Sáez López
- Department of Orthogeriatrics, Hospital Universitario Fundación Alcorcon, Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain
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12
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Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord 2018; 19:369. [PMID: 30314495 PMCID: PMC6186067 DOI: 10.1186/s12891-018-2276-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures are a major worldwide public health problem and includes two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. The aim of this study on patients with trochanteric and subtrochanteric hip fractures was to describe the epidemiology, treatment and outcome in terms of mortality within the context of a large register study. METHODS A descriptive epidemiological register study including patients registered in the national Swedish Fracture Register from January 2014 to December 2016. Inclusion criteria were all primary surgically treated traumatic non-pathological trochanteric and subtrochanteric femoral fractures in patients aged 18 years and above. Individual patient data (age, gender, injury location, injury cause, fracture type, treatment and timing of surgery) were retrieved from the register database. Mortality data was obtained via linkage to the Swedish Death Register. RESULTS A total of 10,548 consecutive patients were identified and included in the study. The mean (±SD) age for all patients was 82 ± 11 years and the majority of the patients were females (69%). Most of the fractures were caused by a fall at the same level (83%) at the patients' accommodation (75%). Fractures were classified using the AO/OTA classification as 31-A1 in 29%, as 31-A2 in 49% and as 31-A3 in 22% of the cases. The most commonly used implant was a short antegrade intramedullary nail (42%), followed by a plate with sliding hip screw (37%). With increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails. The majority of the patients were operated within 36 h (90%). There was a higher mortality at 30 days and 1 year for males, and for all those who were delayed to surgery > 36 h. CONCLUSION Safety measures to prevent fall at elderly patient's accommodation might be a way to reduce the number of trochanteric and subtrochanteric hip fractures. Surgery as soon as possible without delay should be considered to reduce the mortality rate. The selection of surgical methods depends on the fracture complexity.
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Affiliation(s)
- Leif Mattisson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet. Department of Orthopaedics, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Alicja Bojan
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, 431 80 Mölndal, Sweden
| | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet. Department of Orthopaedics, Stockholm South General Hospital, 11883 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, 17176 Stockholm, Sweden
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13
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Pueyo-Sánchez MJ, Larrosa M, Surís X, Sánchez-Ferrin P, Bullich-Marin I, Frigola-Capell E, Ortún V. Association of orthogeriatric services with long-term mortality in patients with hip fracture. Eur Geriatr Med 2018; 9:175-181. [PMID: 34654256 DOI: 10.1007/s41999-018-0028-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/10/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the impact of the comprehensive orthogeriatric care model (OGM) on 2-year survival, length of stay (LOS), discharges to nursing homes, and antiosteoporotic treatment (AOT) in patients with hip fracture. METHODS Retrospective cohort study. Hospitals were classified as OGM if the patient was cared for in a comprehensive orthogeriatric unit. We included data from patients ≥ 65 years old discharged between 2012 and 2013. The main outcome was 12- and 24-month mortality. The variables collected were sex, type of fracture, comorbidities, AOT, LOS, and discharge to nursing homes. Survival analysis was performed with Kaplan-Meier method and comparison with Mantel-Haenszel test. Factors associated with death were determined by logistic regression. RESULTS First admissions in the 12 (out of 32) hospitals with OGM were 3580 of 9215 (38.8%). Patients in OGM had more comorbidities and discharges to nursing homes, shorter LOS, and less prescription of AOT. Two years after the admission the deceased patients were 3000 (32.6%). The survival was lower in males (p < 0.001), in the older age groups (p < 0.001), and in patients with Charlson > 1 (p < 0.001). Factors associated with increased risk of death at 12 and 24 months (logistic regression) were male gender, age and Charlson > 1, while care in the OGM decreased the risk. OGM benefited more patients > 80 years and those with Charlson < 1. CONCLUSIONS Patients admitted in OGM have shorter stays, more discharges to nursing homes, lower prescription of AOT, and better 12- and 24-month survival adjusted by sex, age, and comorbidities compared to non-OGM care.
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Affiliation(s)
- Maria-Jesús Pueyo-Sánchez
- Department of Health, Master Plan of Musculoskeletal Diseases, Travessera de les Corts 139-151, 08028, Barcelona, Spain. .,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.
| | - M Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Travessera de les Corts 139-151, 08028, Barcelona, Spain.,Rheumatology Department, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - X Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Travessera de les Corts 139-151, 08028, Barcelona, Spain.,Rheumatology Department, Hospital General de Granollers, Granollers, Spain.,School of Medicine and Health Sciences, International University of Catalonia, Sant Cugat del Vallès, Spain
| | - P Sánchez-Ferrin
- Department of Health, Master Plan of Social and Health Care, Barcelona, Spain
| | - I Bullich-Marin
- Department of Health, Master Plan of Social and Health Care, Barcelona, Spain
| | - E Frigola-Capell
- Department of Health, Master Plan of Musculoskeletal Diseases, Travessera de les Corts 139-151, 08028, Barcelona, Spain.,Jordi Gol Institute for Research in Primary Care, IDIAP Jordi Gol, Barcelona, Spain
| | - Vicente Ortún
- Department of Economics, Pompeu Fabra University, Barcelona, Spain
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