Trends in incidence rates (IR) of hip/femur fractures in five european countries: A comparison using electronic health care records (E-HCR)

Abstract

Background: Hip fractures represent a major public health challenge in developed countries and Europe holds an important share of this disease worldwide. Although there are many studies, direct cross-national comparisons using a common methodology are scarce. Objectives: We aimed to estimate the IR of hip/femur fractures across five European countries using e-HCR databases (DB) and comparing IR and trends from 2003 to 2009. Methods: A descriptive study on the incidence of hip/ femur fractures was performed within seven DB from Denmark (national prescription registry), the Netherlands (Mondriaan AHC, NPCRD), Germany (Bavarian Claims), Spain (BIFAP) and the UK (THIN, CPRD), based on the same protocol. Yearly IR of hip/femur fractures were calculated for the general population and for those aged ≥ 50 years. Trends over time were evaluated using linear regression analysis for both crude and standardized IR, and annual change was expressed as a percentage using the first year as reference. Results: Sex and age standardized IR were similar for the UK, the NL and Spanish DBs over the study period, ranging from 7 to 10 per 10,000 person-years for the general population and 15-25 for those aged ≥ 50 years; the German Bavarian Claims DB showed slightly higher IR (about 13 and 30), whereas the Danish DB yielded IR twofold higher (19 and 50, correspondingly). IR increased exponentially with age in both sexes, and the IR ratio female:male was ≥ 2 for patients aged ≥ 70-79 years in most DBs. Statistically significant trends in the standardized IR over time were only shown for the CPRD (UK) (+0.9% per year; p <0.01) and the Danish DB (-1.4% per year; p <0.01) for the general population. Conclusions: Standardized IR of hip/femur fractures were similar in most countries and remained stable over the study period. Denmark presented the highest IR and showed a consistent, though moderate, decline over time. Despite efforts made to prevent this condition, we have not observed a general decline in Europe.