INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

PETERLE, VIVIANE CRISTINA ULIANA; GEBER JUNIOR, JOÃO CARLOS; DARWIN JUNIOR, WILLIAN; LIMA, ALEXANDRE VASCONCELOS; BEZERRA JUNIOR, PAULO EMILIANO; NOVAES, MARIA RITA CARVALHO GARBI

doi:10.1590/1413-785220202803228393

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ORIGINAL ARTICLE, TRAUMA • Acta ortop. bras. 28 (3) • May-Jun 2020 • https://doi.org/10.1590/1413-785220202803228393 copy

INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

INDICADORES DE MORBIDADE E MORTALIDADE POR FRATURAS DE FÊMUR EM IDOSOS: ANÁLISE DE UMA DÉCADA EM HOSPITAIS BRASILEIROS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018.

Methods:

Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72).

Results:

There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00).

Conclusion:

Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

Keywords:
Femur; Aged/Mortality; Risk Factors; Health Systems; Osteoporosis

Sex	Age Group	Number of Hospitalizations	Average length of stay (days)	Deaths	Mortality Rate (%)
Total	Total	480,652	8.9	24,027	5.00
	60 to 64	43,834	8.9	804	1.83
	65 to 69	52,587	8.9	1,269	2.41
	70 to 74	68,129	8.8	2,027	2.98
	75 to 79	87,761	8.8	3,405	3.88
	80 and over	228,341	8.9	16,522	7.24
Male	Total	153,608	9.0	8,368	5.45
	60 to 64	22,662	9.1	435	1.92
	65 to 69	22,325	9.1	596	2.67
	70 to 74	23,758	9.0	846	3.56
	75 to 79	26,224	9.0	1,239	4.72
	80 and over	58,639	9.0	5,252	8.96
Female	Total	327,044	8.8	15,659	4.79
	60 to 64	21,172	8.7	369	1.74
	65 to 69	30,262	8.8	673	2.22
	70 to 74	44,371	8.7	1,181	2.66
	75 to 79	61,537	8.8	2,166	3.52
	80 and over	169,702	8.8	11,270	6.64

Year Processing	Hospitalizations (n)	Cost (R$)	Average Value Hospitalization (R$)
Total (2008-2018)	480,652	1,101,072,872.24	2,290.79
2008	32,950	58,704,215.87	1,781.62
2009	36,435	69,269,677.41	1,901.19
2010	35,620	72,767,862.66	2,042.89
2011	38,119	78,749,699.25	2,065.89
2012	38,755	82,170,390.49	2,120.25
2013	41,874	97,259,762.36	2,322.68
2014	44,316	107,536,595.16	2,426.59
2015	47,138	114,839,321.03	2,436.24
2016	52,130	129,496,301.52	2,484.10
2017	55,034	138,627,352.66	2,518.94
2018	58,281	151,651,693.83	2,602.08

Region	Hospitalizations (n)	Total Cost (R$)	Average hospitalization cost (R$)	Average length of stay (days)	Deaths (n)	Mortality Rate
Region	Hospitalizations (n)	Total Cost (R$)	Average hospitalization cost (R$)	Average length of stay (days)	Deaths (n)	(%)
Total	480,652	1,101,072,872.24	2,290.79	8.9	24,027	5
North Region	17,870	39,110,174.72	2,188.59	11.8	692	3.87
Northeast Region	88,452	188,705,323.81	2,133.42	9.6	3,130	3.54
Southeast Region	255,097	587,449,632.96	2,302.85	8.8	14,082	5.52
South Region	90,512	225,474,745.18	2,491.10	7.8	4,816	5.32
Midwest Region	28,721	60,332,995.57	2,100.66	9.1	1,307	4.55

Region/State	Hospitalizations	Average length of stay (days)	Deaths	Mortality Rate (%)
TOTAL	480,652	8.9	24,027	5.00
North Region	17,870	11.8	692	3.87
Amazonas	3,346	14.1	111	3.32
Pará	8,054	8.7	277	3.44
Acre	827	8.9	34	4.11
Amapá	773	19.5	35	4.53
Tocantins	2,258	11.4	105	4.65
Rondônia	2,117	19.2	105	4.96
Roraima	495	8.5	25	5.05
Northeast Region	88,452	9.6	3,130	3.54
Ceará	12,923	10.3	306	2.37
Alagoas	5,765	6.5	146	2.53
Paraíba	8,174	10.1	244	2.99
Pernambuco	17,427	9.7	548	3.14
Rio Grande do Norte	6,554	8.0	211	3.22
Maranhão	5,436	10.5	190	3.50
Piauí	6,666	7.9	261	3.92
Bahia	21,058	9.9	920	4.37
Sergipe	4,449	11.9	304	6.83
Southeast Region	255,097	8.8	14,082	5.52
Minas Gerais	69,801	7.3	3,165	4.53
Espírito Santo	9,071	10.4	482	5.31
São Paulo	136,402	7.8	8,015	5.88
Rio de Janeiro	39,823	14.2	2,420	6.08
South Region	90,512	7.8	4,816	5.32
Rio Grande do Sul	39,164	8.7	1,699	4.34
Paraná	33,324	6.8	1,946	5.84
Santa Catarina	18,024	8.0	1,171	6.50
Mideast Region	28,721	9.1	1,307	4.55
Federal District	4,576	18.7	191	4.17
Mato Grosso	5,301	8.1	225	4.24
Goiás	11,230	6.8	528	4.70
Mato Grosso do Sul	7,614	7.4	363	4.77

Sex	Age Group	Hospitalizations (n)	Total Cost (R$)	Hospitalization Average Cost (R$)	Deaths (n)	Mortality Rate (%)
State: Santa Catarina
	Total	18,024	49,126,435.18	2,725.61	1,171	6.5
Male	80 years old and over	1,896	5,437,021.32	2,867.63	247	13.03
Female	80 years old and over	6,448	17,892,549.71	2,774.90	572	8.87
State: Paraná
	Total	33,324	93,161,247.99	2,795.62	1,946	5.84
Male	80 years old and over	4,159	12,552,222.68	3,018.09	423	10.17
Female	80 years old and over	10,919	32,434,056.18	2,970.42	892	8.17
State: Rio Grande do Sul
	Total	39,164	83,187,062.01	2,124.07	1,699	4.34
Male	80 years old and over	3,680	8,121,912.65	2,207.04	335	9.1
Female	80 years old and over	15,415	32,596,898.39	2,114.62	835	5.42
State: Ceará
	Total	12,923	28,900,973.42	2,236.40	306	2.37
Male	80 years old and over	1,442	3,237,808.28	2,245.36	61	4.23
Female	80 years old and over	4,788	10,432,863.43	2,178.96	142	2.97
State: Alagoas
	Total	5,765	10,405,461.29	1,804.94	146	2.53
Male	80 years old and over	758	1,319,245.37	1,740.43	22	2.9
Female	80 years old and over	1,977	3,686,575.29	1,864.73	81	4.1
State: Sergipe
	Total	4,449	9,117,137.19	2,049.26	304	6.83
Male	80 years old and over	586	1,233,046.04	2,104.17	72	12.29
Female	80 years old and over	1,648	3,506,065.87	2,127.47	157	9.53
State: Bahia
	Total	21,058	45,114,541.03	2,142.39	920	4.37
Male	80 years old and over	2,895	15,841,507.14	2,148.58	317	4.3
Female	80 years old and over	7,173	29,273,033.89	2,139.06	603	4.41
State: Maranhão
	Total	5,436	9,463,191.36	1,740.84	190	3.5
Male	80 years old and over	708	1,150,221.72	1,624.61	44	6.21
Female	80 years old and over	1,629	2,822,523.42	1,732.67	87	5.34
State: Paraíba
	Total	8,174	9,463,191.36	2,191.68	244	3.51
Male	80 years old and over	1,120	2,505,247.24	2,236.83	63	5.63
Female	80 years old and over	3,145	6,913,466.57	2,198.24	117	3.72
State: Pernambuco
	Total	17,427	39,302,298.70	2,255.25	548	3.14
Male	80 years old and over	2,095	4,550,246.74	2,171.96	122	5.82
Female	80 years old and over	6,220	14,128,881,19	2,271.52	255	4.1
State: Piauí
	Total	6,666	12,598,755.69	1,890.00	261	3.92
Male	80 years old and over	832	1,653,334.90	1,987.18	88	6.73
Female	80 years old and over	2,344	4,481,404.60	1,911.86	173	5.38
State: Rio Grande do Norte
	Total	6,554	15,888,204.17	2,424.20	211	3.22
Male	80 years old and over	890	2,246,935.87	2,524.65	44	4.94
Female	80 years old and over	2,674	6,770,452.81	2,531.96	105	3.93

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[1] Correspondence: Viviane Cristina Uliana Peterle. Setor Médico Hospitalar Norte, Conjunto A, Bloco 1, Edifício Fepecs, Asa Norte, Brasília, Brazil, 70710907. vivianepeterle@hotmail.com