Variation in mortality following hip fracture across the Asia Pacific region: Systematic review and proportional meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational studies
PubMed 38941947 · doi:10.1016/j.archger.2024.105519
What was done
Authors conducted a systematic review and random-effects proportional meta-analysis searching five databases (MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane Library) for studies published from 2010 to September 30, 2021. Eligible studies reported in-hospital, 30-day, or 1-year mortality following low-trauma hip fracture hospitalisation in adults aged ≥50 years across the Asia Pacific region, without language or design restrictions. Pooled mortality rates were calculated for countries/regions with at least two studies.
What was found
A total of 244 studies were analyzed: - In-hospital mortality (123 studies, 1,382,810 patients, 13 countries/regions): ranged from 1.4% in Japan (95% CI 1.2–1.7), Singapore (95% CI 1.0–1.6), China (95% CI 0.8–2.3), and Hong Kong SAR (95% CI 0.8–2.6) to 5.5% (95% CI 4.1–7.2) in New Zealand. - 30-day mortality (92 studies, 628,450 patients, 13 countries/regions): ranged from 1.2% in Japan (95% CI 0.9–1.5) and Thailand (95% CI 0.7–2.0) to 7.4% (95% CI 7.0–7.8) in Australia. - 1-year mortality (142 studies, 1,139,752 patients, 14 countries/regions): ranged from 10.8% (95% CI 9.6–12.1) in Singapore to 23.3% (95% CI 22.3–24.5) in Australia and 23.8% in New Zealand (95% CI omitted in abstract).
Why it matters
This study provides comprehensive regional benchmarks showing that short-term mortality after hip fracture is up to four-fold lower and 1-year mortality two-fold lower in Asian countries compared with Australia and New Zealand.
Limits
The review pools observational studies with differing baseline patient characteristics, surgical timing, and perioperative care practices. Specific 95% confidence intervals for New Zealand 1-year mortality were not reported in the abstract, and causes driving the regional mortality disparities were not evaluated.
Cited by
- contradicts For people over age 65 who fall, break a bone, and are hospitalized, there is a greater than 50% chance of death within one year.