Risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawaiʻi: higher mortality risk among Native Hawaiians and other Pacific Islanders

• Published in: Osteoporosis international 2024-11, Vol.35 (11), p.1931-1941
• Main Authors: Taylor, Luke, Matsunaga, Masako, Ahn, Hyeong Jun, Siu, Andrea M., Lim, Sian Yik
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Body Mass Index; Body weight; Demographics; Endocrinology; Female; Fractures; Hawaii - epidemiology; Health risks; Hip; Hip Fractures - ethnology; Hip Fractures - mortality; Hip joint; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Native Hawaiian or Other Pacific Islander - statistics & numerical data; Older people; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - ethnology; Osteoporotic Fractures - mortality; Pacific Island People; Pacific Islander people; Regression analysis; Retrospective Studies; Rheumatology; Risk Factors; Sex; Sex Factors; Underweight
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-024-07195-1

Summary We studied factors affecting osteoporotic hip fracture mortality in Hawaiʻi, a region with unique geography and racial composition. Men, older adults, higher ASA score, lower BMI, and NHPI race were associated with higher mortality. This is the first study demonstrating increased mortality risk after hip fracture in NHPI patients. Purpose To estimate mortality rates and identify specific risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawaiʻi. Methods A retrospective review of adults (≥ 50 years) hospitalized with an osteoporotic hip fracture at a large multicenter healthcare system in Hawaiʻi from 2011 to 2019. The Kaplan–Meier curves and log-rank tests examined survival probability by sex, age group, race/ethnicity, primary insurance, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status classification. After accounting for potential confounders, adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were obtained from Cox proportional hazards regression models. Results We identified 1755 cases of osteoporotic hip fracture. The cumulative mortality rate 1 year after fracture was 14.4%. Older age (aHR 3.50; 95% CI 2.13–5.76 for ≥ 90 vs 50–69), higher ASA score (aHR 5.21; 95% CI 3.09–8.77 for ASA 4–5 vs 1–2), and Native Hawaiian/Pacific Islander (NHPI) race (aHR 1.84; 95% CI 1.10–3.07 vs. White) were independently associated with higher mortality risk. Female sex (aHR 0.64; 95% CI 0.49–0.84 vs male sex) and higher BMI (aHR 0.35; 95% CI 0.18–0.68 for obese vs underweight) were associated with lower mortality risk. Conclusion In our study, men, older adults, higher ASA score, lower BMI, and NHPI race were associated with significantly higher mortality risk after osteoporotic hip fracture. NHPIs are an especially vulnerable group and comprise a significant portion of Hawaiʻi’s population. Further research is needed to address the causes of higher mortality and interventions to reduce hip fractures and associated mortality.