7473 Mortality following Hip Fracture among Black and White Women in a Western US Healthcare System
Authors: Lo J C , Chandra M , Yang W , Ozomaro U , Sharma M D , Darbinian J A , Lee C , Wheeler A L , Khan M M 
Published: October 2024

Abstract
Disclosure: J.C. Lo: None. M. Chandra: None. W. Yang: None. U. Ozomaro: None. M.D. Sharma: None. J.A. Darbinian: None. C. Lee: None. A.L. Wheeler: None. M.M. Khan: None.
Background: Prior studies using US Medicare data demonstrate that Black women have higher mortality after hip fracture than White women. However, few studies have examined findings specific to the Western US. We previously found that 1-year mortality after hip fracture (in 2000-2010) was similar among Black and White women in a Western US healthcare system. We now examine 6-month and 1-year mortality in an expanded cohort of Black and White women with hip fracture in the same healthcare system. Methods: This retrospective study includes data from non-Hispanic White and Black women aged ≥65y in a Western US healthcare system who were hospitalized with hip fracture during 2000-2019. The outcome was all-cause mortality, within 6-months and 1-year after hip fracture. Covariates included age at hip fracture, femoral neck vs pertrochanteric (hip) fracture, year of fracture, prior clinical fracture (diagnosed in the prior 5 years), Charlson-Deyo Comorbidity index (CCI based on inpatient/outpatient data in the prior year and during hip fracture hospitalization) and diabetes (diagnosed in the prior 5 years or during hip fracture hospitalization). Modified Poisson regression was used to examine mortality after hip fracture (Black vs White women), adjusting for (a) age, fracture type, year and (b) age, fracture type, year, CCI, prior fracture and diabetes. Results: The cohort included 691 Black women (age 82.9 ± 8.0y; 43.4% age ≥85y) and 20,450 White women (age 82.8 ± 7.7y; 44.2% age ≥85y) with hip fracture in 2000-2019. Black women had a similar proportion with femoral neck fracture (58.2% vs 55.2%) but were more likely to have prior fracture (23.0% vs 33.5%), diabetes (35.2% vs 18.2%), and higher CCI vs White women. For Black vs White women, respectively, group differences in 6-month (18.4% [95% confidence interval 15.7-21.4%] vs 16.4% [15.9-16.9%], p=0.12) and 1-year mortality (23.2% [20.2-26.5%] vs 22.1% [21.4-22.6%], p=0.49) were not significant. In multivariable analyses, the relative risk of death at 1-year for Black (vs White) women was 1.03 [0.90-1.19] adjusting for age, year, fracture type and 0.97 [CI 0.84-1.11] adjusting for age, year, fracture type, CCI, prior fracture, and diabetes. The relative risk of death at 6-months for Black (vs White) women was 1.05 [0.89-1.23] adjusting for covariates. Conclusions: In a Western US healthcare system, differences in 6-month and 1-year mortality post-hip fracture were small and not significant for Black and White women aged ≥65y, after accounting for age and comorbidity burden. However, the number of Black women was small, and data on social factors, frailty, post-fracture morbidity, and other health factors were not available. Nonetheless, these results suggest that racial and ethnic differences in mortality after hip fracture may vary by geographic region. Hip fracture outcomes in larger populations of Black women in the Western US should be examined.
Presentation: 6/3/2024