The Widowhood Effect on Mortality in Older Patients with Hip Fracture

Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture.

Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted.

Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054-1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038-1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607-2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female.

Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.