A total of 32 590 people aged 65 years and over were admitted to hospital as emergencies with fractured neck of femur between 1968 and 1998, of whom 26 687 (81.9%) were women. The mean age of the patients was 81.5 (SD 7.4) years (men 79.6 (7.5) years, women 82.0 (7.4) years).
The age distribution of patients admitted with fractured neck of femur increased significantly over the study period (χ2 test for trend = 60.7, df = 1, P < 0.001 for men; χ2 test for trend = 193.6, df = 1, P < 0.001 for women; ). For example, 611 (31.6%) of the patients admitted in 1968-73 were aged 85 years or over, compared with 3200 (41.0%) in 1994-8.
Age distribution of patients admitted to hospital with fractured neck of femur over time, 1968-98. Values are numbers (percentages)
For both men and women, case fatality rates declined during the early part of the study period and then levelled off from the early 1980s (figs and ). Because the study population had expanded from six to eight districts in 1987, we analysed the trends separately for the populations covered by the six and eight districts; the trends in both populations were similar, and the increase in deaths in the late 1980s was still evident.
Age and sex adjusted trends in case fatality rates for fractured neck of femur 30, 90, and 365 days after hospital admission, 1968-98
Age and sex adjusted trends in case fatality rates for fractured neck of femur years at 30, 90, and 365 days after hospital admission, 1968-98, (top) in people aged 65-74; (middle) in people aged 75-84; (bottom) in people aged ≥85
Logistic regression modelling showed that, between 1968-73 and 1979-83, significant downward trends occurred in the annual age adjusted case fatality rates for women at 30, 90, and 365 days (all P < 0.001), and for men at 90 days (P < 0.05). The study of rates had less statistical power in men than women because of lower incidence of fracture, and downward trends did not reach significance for the rates at 30 and 365 days for men in the earlier years (). From the 1984 onwards, annual rates did not decline further.
Age adjusted, sex specific odds ratios for quinquennial time period and marital status, and age and sex adjusted odds ratios for social class, on case fatality rates after hospital admission for fractured neck of femur, 1968-98
Mortality was significantly higher (P < 0.001) in social classes IV and V than in classes I and II (). The odds ratio for IV and V to I and II was 2.47 at 30 days (95% confidence interval 1.79 to 3.42) and declined to 1.75 (1.34 to 2.27) at one year. Mortality was also higher in class III, relative to classes I and II, for the case fatality rate at 90 days (P < 0.01) and at one year (P < 0.05). After adjustment for age group, marital status had no significant effect on survival in men, but mortality was significantly lower in married women than in single women at 90 days (P < 0.01) and at one year (P < 0.001).
For both men and women, case fatality rates increased greatly with increasing age (). For example, in the period 1984-98 at 30 days after admission, they rose with age in men from 4.4% (2.3% to 6.5%) at age 65-69 to 18.6% (15.9% to 21.4%) at age 85-89 and 31.4% (26.6% to 36.1%) at age 90 or over. In each age group, the rates were consistently higher in men than in women. The rates were also significantly higher in 1968-83 than in 1984-98 for most individual age-sex groups.
Age and sex specific case fatality rates (95% confidence intervals) after hospital admission for fractured neck of femur, 1968-83 and 1984-98
shows standardised mortality ratios for men and women separately during the 31 year period 1968-98. These calculations compare mortality in people with fractures with mortality in the general populations of men and women of the same age. At one month after hospital admission, mortality was 16 times higher in men and 12 times higher in women than in the general populations of men and women of similar age. By month 2, the standardised mortality ratios had declined substantially, but they were significantly higher in men than women in four of the first five months after admission. The ratios for both men and women remained higher than those in the general population throughout the full year after admission, but differences between men and women were not significantly different in months 6-12.
Standardised mortality ratios after hospital admission for fractured neck of femur in men and women, 1968-98. Bars are 95% confidence intervals