The authors have no conflict of interest.
Version of Record online: 1 DEC 2003
Copyright © 2003 ASBMR
Journal of Bone and Mineral Research
Volume 18, Issue 12, pages 2231–2237, December 2003
How to Cite
Wehren, L. E., Hawkes, W. G., Orwig, D. L., Hebel, J. R., Zimmerman, S. I. and Magaziner, J. (2003), Gender Differences in Mortality After Hip Fracture: The Role of Infection. J Bone Miner Res, 18: 2231–2237. doi: 10.1359/jbmr.2003.18.12.2231
Portions of this report were presented orally at the World Congress on Osteoporosis 2000, Chicago, IL, June 15–18, 2000 at a plenary session of the 23rd Annual Scientific Meeting of the American Society for Bone and Mineral Research, Phoenix, Arizona, October 12–16, 2001, and as a plenary poster at the 22nd Annual Scientific Meeting of the American Society for Bone and Mineral Research, Toronto, Ontario, Canada, September 22–26, 2000.
- Issue online: 2 DEC 2009
- Version of Record online: 1 DEC 2003
- Manuscript Accepted: 23 JUL 2003
- Manuscript Revised: 21 JUL 2003
- Manuscript Received: 14 FEB 2003
- population studies
Possible explanations for the observed gender difference in mortality after hip fracture were examined in a cohort of 804 men and women. Mortality during 2 years after fracture was identified from death certificates. Men were twice as likely as women to die, and deaths caused by pneumonia/influenza and septicemia showed the greatest increase.
Introduction: Men are more likely to die after hip fracture than women. Gender differences in predisposing factors and causes of death have not been systematically studied.
Materials and Methods: Participants (173 men and 631 women) in the Baltimore Hip Studies cohort enrolled in 1990 and 1991, at the time of hospitalization for hip fracture, were followed longitudinally for 2 years. Cause-specific mortality 1 and 2 years after hip fracture, identified from death certificates, was compared by gender and to population rates.
Results and Conclusions: Men were twice as likely as women to die during the first and second years after hip fracture (odds ratio [OR], 2.28; 95% CI, 1.47, 3.54 and OR, 2.21; 95% CI, 1.48, 3.31). Prefracture medical comorbidity, type of fracture, type of surgical procedure, and postoperative complications did not explain the observed difference. Greatest increases in mortality, relative to the general population, were seen for septicemia (relative risk [RR], 87.9; 95% CI, 16.5, 175 at 1 year and RR, 32.0; 95% CI, 7.99, 127 at 2 years) and pneumonia (RR, 23.8; 95% CI, 12.8, 44.2 at 1 year and RR, 10.4; 95% CI, 3.35, 32.2 at 2 years). The magnitude of increase in deaths caused by infection was greater for men than for women in both years. Mortality rates for men and women were similar if deaths caused by infection were excluded (3.46 [1.79, 6.67] and 2.47 [1.63, 3.72] at 1 year and 0.96 [0.48, 1.91] and 1.26 [0.80, 1.98] at 2 years). Deaths related to infections (pneumonia, influenza, and septicemia) seem to be largely responsible for the observed gender difference. In conclusion, an increased rate of death from infection and a gender difference in rates persists for at least 2 years after the fracture.