2015至2021年天津市天津医院髋部脆性骨折患者的生存率分析

Analysis of survival rate after hip fragility fracture in Tianjin Hospital from 2015 to 2021

目的分析2015至2021年天津市天津医院髋部脆性骨折患者的生存率变化趋势及性别、婚姻状况、年龄、合并症数量对生存率的影响。方法检索天津市天津医院数据库2015年1月1日至2021年12月31日因髋部脆性骨折入院的患者12570例,男3934例、女8636例,入院时年龄分别为(74.11±9.50)岁和(74.62±8.99)岁。于2022年5月23日通过身份证号与天津市全员人口信息数据库进行比对,死亡2054例,其中男804例、女1250例,死亡时年龄分别为(81.34±7.88)岁和(81.92±7.42)岁。收集患者生存状况,以3个月为时间间隔,计算生存率、累积生存率,分析随时间变化累积生存率的变化规律,绘制Kaplan-Meier生存曲线计算总体累积生存率,分析性别、年龄(>70岁和≤70岁)、婚姻状况(有配偶和无配偶)、合并症数量(≥2个和<2个)对生存率的影响。采用Joinpoint回归分析髋部脆性骨折的累积死亡率变化趋势折点。结果骨折后全部死亡患者生存期为13(3,31)个月,其中男性为11(2,27)个月、女性为15(4,32)个月,差异有统计学意义(Z=73.77,P<0.001)。Joinpoint回归显示髋部脆性骨折后9个月为累积死亡率变化趋势折点,9个月前(年变化率为47%)累积死亡率变化幅度较大,9个月后(年变化率为1%)累积死亡率变化较平缓,折点前后年变化率比较差异有统计学意义(P<0.05)。死亡患者入院时年龄为(80.11±7.71)岁、未死亡患者为(73.36±9.01)岁,差异有统计学意义(t=31.80,P<0.001)。合并症数量经正态化转换后,死亡患者为(0.20±0.93)个、未死亡患者为(0.00±0.87)个,差异有统计学意义(t=88.81,P<0.001)。发生髋部脆性骨折后男性累积生存率低于女性、无配偶低于有配偶患者、年龄>70岁低于≤70岁患者、合并症数量≥2个低于<2个的患者,差异均有统计学意义(P<0.05)。结论髋部脆性骨折后9个月内累积生存率下降最明显,临床上需密切随访;男性、无配偶、年龄>70岁、合并症数量≥2个会增加髋部脆性骨折后的死亡风险,导致生存率降低。

Objective To analyze the change trend of survival rate after hip fragility fracture in Tianjin Hospital from 2015 to 2021,and the influence of gender,marital status,age and number of complications on survival rate.Methods From January 1,2015 to December 31,2021,a total of 12,570 patients with fragility fracture of hip were retrieved,including 3,934 males and 8,636 females.The age at admission was 74.11±9.50 years and 74.62±8.99 years respectively.By comparing the ID number with the Tianjin population information database,2,054 cases died,including 804 males and 1,250 females,aged 81.34±7.88 years and 81.92±7.42 years respectively at the time of death.Acquire the patient's survival status,calculate the cumulative survival rate at 3 month intervals,study the change rule of the cumulative survival rate over time,and use Kaplan-Meier method to calculate the cumulative survival rate of the whole population and the impact of gender,marital status,age,and number of complications on the survival rate.Results The median survival time of all the dead people after fracture was 13(3,31)months,including 11(2,27)months for males and 15(4,32)months for females.Joinpoint regression showed that 9 months after the hip fragility fracture was the break point of the survival rate.The mortality rate changed significantly within 9 months after fracture(the annual change rate was 47%),and slowed down 9 months later(the annual change rate was 1%).There was a statistically significant difference in trend detection before and after the break point(P<0.05).The age at admission was 80.11±7.71 years for the dead and 73.36±9.01 years for the non dead,with a statistically significant difference(t=31.80,P<0.001).After normalization,the number of complications was 0.20±0.93 among the dead and 0.00±0.87 among the non dead,with a statistically significant difference(t=88.81,P<0.001).The survival rate of men after hip fracture is lower than that of women,the number of people without spouse is lower than that of people with spouse,the number of people with more than 70 years old is lower than that of people with less than 70 years old,and the number of complications≥2 people is lower than that of people with less than 1 complication,all of which are statistically significant(P<0.05).Conclusion The survival rate within 9 months after the occurrence of hip fragility fracture decreased significantly,and it needs to be tracked and managed for at least 9 months to effectively reduce the risk of death;Male,no spouse,age>70 years old,number of complications≥2 will increase the risk of death after hip fragility fracture,leading to reduced survival rate of patients.