Mortality and Risk Factors After Hip Fracture in Patients Aged 50 Years and Older: A Minimum 10-Year Follow-up Using...

Hip fractures are associated with a high mortality rate; however, long-term follow-up studies are limited. This study aimed to evaluate mortality and its associated risk factors in patients with hip fractures over a minimum follow-up period of 10 years within a prospective cohort.

Data were obtained from a cohort of hip fractures on Jeju Island (2002-2011). Mortality was assessed in patients with at least 10 years of follow-up. Among 1,952 eligible patients, survival outcome was confirmed for 1,840 patients with 112 lost to follow-up. Mortality rates were estimated using Kaplan-Meier analysis. Risk factors were examined with log-rank tests and Cox proportional hazards regression, including sex, age, fracture type, subsequent fracture, surgical intervention and comorbidity.

Among 1,840 patients, 1,545 deaths and 295 survivors were identified. Cumulative mortality was 17.1% at 1 year, 32.9% at 3 years, 46.7% at 5 years, and 71.4% at 10 years. Kaplan-Meier analysis showed significant differences by age (P < 0.001), type of fracture (P < 0.001), surgical treatment (P = 0.004), and comorbidity (P < 0.001). Multivariate Cox regression identified age, sex, surgery and comorbidity as independent predictors: advanced age, male sex, non-operative management and high comorbidity burden were significantly associated with increased mortality.

Hip fracture patients exhibit steadily increasing mortality, exceeding 70% at 10 years. Advanced age, male sex, lack of surgical treatment and high comorbidity burden are independent risk factors. Strategies targeted at these high-risk groups are essential to improve long-term survival.