Factors associated with mortality due to fall-related hip fracture in older adults

Abstract

The population structure is changing due to the entry into an aging society and the frequency of hip fractures is increasing due to various accidents. Among them, hip fractures due to falls have a high risk of death. To reduce the mortality rate from these hip fractures and to come up with countermeasures, an understanding of the factors affecting the death is needed. This study established a database for 3,892 hip fracture patients aged 65 or older from the Korea Disease Control and Prevention (KCD-10) through the data inquiry of discharge damage in the Centers for Disease Control and Prevention (2010-2014). Factors affecting death of hip fracture due to falling were identified according to demographic, pathological, and fall-related characteristics. Computational statistics were processed using the difference between death and non-occurrence variables due to hip fractures and the demographic characteristics, disease characteristics, fall-related characteristics of those aged 65 and older, and factors affecting mortality. The difference between the parameters of the mortality and non-occurrence due to hip fractures was analyzed by x2-test and was analyzed by Cox-hazard proportional risk to measure the effect on death after hip fracture. According to the statistical analysis, men were statistically more at risk than women in the case of gender, given the sociological characteristics of the factors affecting the death of hip fracture patients due to falls (p<).001 ). In age, 75 to 84 years of age were more dangerous than 65 to 74 years of age, but were not statistically significant (p = .254), and those over 85 years of age were significantly more dangerous than 65 to 74 years of age ( p<).001 ). In the pathological nature, groups of patients without osteoporosis were statistically significantly more dangerous (p<.001). The military with Parkinson was statistically more dangerous than without Parkinson (p=.028). Deaths in counties with relatively high CCI were significantly more dangerous than those with relatively low CCI (p<.001). In the form of fractures, femur tibial fractures were statistically more dangerous than electronic fractures (p=.036). A group of patients who did not operate in the presence of surgery was statistically significantly more dangerous (p<.). Compared to 100~299 units in the medical institution disease constants and 300~499, 500~999 and over 1000 groups with larger lesions, the larger the medical institution disease constants were statistically more dangerous (p=.032). Factors affecting the death of a site in case of damage were residential areas, collective facilities (care centers, hospice facilities, shelter, etc), roads, transportation areas, medical facilities, schools, sports facilities, and outdoor areas, which were statistically more dangerous than the military where the damaged market place was located (p=039). Factors that contribute to death from damage were statistically more dangerous during treatment and during other accidents during daily life (found lying down on the road, unclear transportation accidents), exercise, leisure, education, etc., during treatment, and in the absence of income from work, and during treatment and other accidents during the day of damage (p=.015). In this study, the risk of death in hip joint patients due to falls was shown to be high depending on gender, age, co-morbidities, fracture type, surgical condition, damaged site and damage activity. As the number of elderly people increases, the importance of fall and policies to prevent hip fractures are needed more. In order to reduce hip fractures caused by falls, not only preventive policies but also environmental cleanup and rapid response by medical institutions should prevent death. Based on these findings, it is hoped to be used as a basis for establishing policies that can increase the survival rate of hip patients and actively manage the fall of senior citizens aged 65 or older in Korea.

고령화 사회 진입으로 인한 인구구조가 변화하고 각종 사고로 고관절 골절발생 빈도가 높아지고 있다. 그 중 낙상으로 인한 고관절 골절은 사망 위험이 높다. 이러한 노인 고관절 골절에 의한 사망률을 저하 시키고 대책을 마련하기 위해서는 사망에 영향을 미치는 요인에 대한 파악이 필요하다. 본 연구는 질병관리본부에서 시행한 퇴원손상심층조사(2010년~2014년) 자료를 원자료로 하여 손상외인에서 한국질병사인분류(KCD-10) 65세 이상 낙상으로 인한 고관절 골절환자 3892명에 대한 데이터베이스를 구축하였다. 낙상으로 인한 고관절 골절이 사망에 영향을 미치는 요인을 인구사회학적, 질환/골절치료적, 낙상관련특성에 따라 알아보았다. 65세 이상 낙상으로 인한 고관절골절 대상자의 인구학적 특성, 질병/골절치료적 특성, 낙상관련 특성과 고관절골절로 인한 사망발생군과 비발생군의 변수들의 차이와 사망발생에 영향을 주는 요인 SPSS ver .23.0을 이용하여 전산통계 처리 하였다. 고관절골절로 인한 사망발생군과 비발생군의 변수들의 차이는 x²-test 로 분석하였고 고관절 골절 후 사망에 미치는 영향을 측정하기 위해 콕스 비례 위험(Cox-hazard proportional regression analysis)으로 분석하였다. 통계분석 결과, 여성보다 남성이, 65~74세 보다 75~84세, 85세 이상 연령이 높을수록, 골다공증이 없고, 파킨슨, 울혈성 심부전, 뇌혈관질환, 신장질환, 암, 중증 간질환 있거나, CCI가 높거나, 경부골절이거나, 수술을 하지 않았을 경우, 병상수가 클수록, 손상시 장소가 주거지 보다 집단시설(요양소, 호스피스시설, 쉼터 등), 의료기관에서, 손상시 활동은 일상생활중에서 보다 치료중과 기타사고일 경우 사망위험이 높은 것으로 나타났다. 연구 결과에서 보듯이 사망위험 요인은 질병적 요인뿐만 아니라 성별, 연령, 골절치료, 장소, 활동 다방면으로 영향이 있는 것으로 나타났다. 노인의 낙상으로 인한 고관절골절을 막기위한 정책과 의료기간의 표준지침과 환경적 개선에 대한 인식이 부재하다는 것을 알 수 있다. 앞으로 노인인구가 늘어남에 따라 낙상의 중요성과 고관절골절을 예방의 필요성이 더욱 증가할 것으로 예상되는 바, 본 연구 결과를 바탕으로 국내 65세 이상 노인의 낙상으로 인한 고관절 환자의 생존율을 높이고 적극적으로 관리할 수 있는 정책 수립에 활용되고 의료기관에서는 신속한 대응 지침이 확립되며 지역사회와 개인에게는 위험한 환경 정리를 위한 근거자료로 활용되기를 바란다.