Race and sex differences in hip fracture incidence

Incidence rates for hip fracture in the United States were estimated using non-federal hospital discharges from the National Hospital Discharge Survey for the years 1974-1979. Age-specific incidence curves for women and for men showed similar patterns of increase in risk with age, with risks approximately doubling every five years after age 50. Age-specific rates by five-year age groups were compared among the four race-sex groups. No significant differences were observed between Black females, Black males, and White males. In contrast, rates for White females were one and one-half to four times those for Black females after age 40 and were approximately double those for White males after age 50. Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed these relationships. In the Washington study, White women were at twice the risk for hip fracture (controlled for age) compared with Black women and at 2.7 times the risk for hip fracture (controlled for age) compared to White men. No significant differences were observed between Black women and Black men.     

Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989.

Whereas fractures related to osteoporosis have become a pressing public health concern, relatively few epidemiologic studies have focused on vertebral fractures. To shed further light on the occurrence of this injury, we collected data from the Health Care Financing Administration on 151,986 discharges listing a diagnosis of vertebral fracture over a 4-year period. After adjusting for age, white women experienced the highest rates of discharge, at 17.1 per 10,000 per year, followed by white men (9.9 per 10,000), black women (3.7 per 10,000), and black men (2.5 per 10,000). Among white women, discharge rates rose exponentially from 5.3 discharges per 10,000 population at age 65 to nearly 47.8 per 10,000 at age 90. White men, black women, and black men experienced less dramatic age-related increases in discharge rates. The similarity of these patterns to discharge rates for hip fracture suggests that the race-sex differences in vertebral fracture discharge rates may be due to differences in the incidence of vertebral fracture.     

Sex-specific and race-specific hip fracture rates.

Sex-, race- and age-specific hip fracture rates were determined using Health Care Financing Administration data for Medicare-reimbursed hip fracture hospitalizations from 1980 to 1982. Rates were highest in White women, lowest in Black men, and intermediate in White men and Black women. Proportions of hip fracture patients dying during hospitalization and those discharged to nursing homes, respectively, were: White men (10.5%; 49%); Black men (9.3%; 32%); White women (5.0%; 54%); and Black women (8.2%; 30%).     

Hip fracture incidence among the old and very old: a population-based study of 745,435 cases.

Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds. Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively.     

Excess mortality attributable to hip fracture in white women aged 70 years and older.

OBJECTIVE: The purpose of this study was to estimate the excess mortality attributable to hip fracture. METHODS: The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). RESULTS: After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with three or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100: the effect of the fracture had disappeared in these groups by 4 years. In contrast, those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. CONCLUSIONS: There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture.     

Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.     

Body mass index in young adults: Associations with parental body size and education in the CARDIA Study.

OBJECTIVES: Associations of parental education, parental body size, and offspring's education with body mass index and 7-year change in body mass index were examined among participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS: CARDIA is a study of coronary artery disease risk factors in 5115 Black and White persons aged 18 to 30 at baseline. Analyses of covariance were carried out with body mass index and change in body mass index as the dependent variables, and with parental education, parental body size, and participant education as the major independent variables. RESULTS: Father's body size was positively associated with participant's baseline body mass index among Black men, White men, and White women. Mother's body size was positively associated with baseline body mass index among all race-sex groups, and with change in body mass index among White women. Father's education was inversely associated with baseline body mass index among Black men and White women, and with change among White women. CONCLUSIONS: Parental education may influence body mass index and changes in young adulthood, especially among White women. Such associations may be both genetic and environmental and may be important for obesity prevention efforts.     

Local increases in coronary heart disease mortality among blacks and whites in the United States, 1985-1995

OBJECTIVES: This study analyzed coronary heart disease (CHD) mortality trends from 1985 to 1995, by race and sex, among Black and White adults 35 years and older to determine whether adverse trends were evident in any US localities. METHODS: Log-linear regression models of annual age-adjusted death rates provided a quantitative measure of local mortality trends. RESULTS: Increasing trends in CHD mortality were observed in 11 of 174 labor market areas for Black women, 23 of 175 areas for Black men, 10 of 394 areas for White women, and 4 of 394 areas for White men. Nationwide, adverse trends affected 1.7% of Black women, 8.0% of Black men, 1.1% of White women, and 0.3% of White men. CONCLUSIONS: From 1985 to 1995, moderate to strong local increases in CHD mortality were observed, predominantly in the southern United States. Black men evidenced the most unfavorable trends and were 25 times as likely as White men to be part of a local population experiencing increases in coronary heart disease mortality.     

Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States

Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (delta rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other three race-sex groups. During 1976-85 there was also a leveling off in the average annual per cent change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade.     

Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data.

We examined the incidence of hip fracture in Non-Hispanic White, Hispanic, Black, and Asian Americans for the years 1983 and 1984 using a data base which contains a summary of all hospitalizations for the State of California. We found a consistently lower risk for hip fracture after age 60 in Hispanic, Black, and Asian American females than in White females who were not Hispanic. Overall age-adjusted hip fracture rates in Hispanic, Black, and Asian females were 49.7, 57.3, and 85.4, respectively, and 140.7/100,000 in White females who were not Hispanic. These differences were not found in males, although Whites (not Hispanic) had the highest incidence of hip fractures among males.     

Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study

Despite mounting evidence that sleep duration is a risk factor across diverse health and functional domains, little is known about the distribution and determinants of sleep. In 2003-2004, the authors used wrist activity monitoring and sleep logs to measure time in bed, sleep latency (time required to fall asleep), sleep duration, and sleep efficiency (percentage of time in bed spent sleeping) over 3 days for 669 participants at one of the four sites of the Coronary Artery Risk Development in Young Adults (CARDIA) study (Chicago, Illinois). Participants were aged 38-50 years, 58% were women, and 44% were Black. For the entire sample, mean time in bed was 7.5 (standard deviation (SD), 1.2) hours, mean sleep latency was 21.9 (SD, 29.0) minutes, mean sleep duration was 6.1 (SD, 1.2) hours, and mean sleep efficiency was 80.9 (SD, 11.3)%. All four parameters varied by race-sex group. Average sleep duration was 6.7 hours for White women, 6.1 hours for White men, 5.9 hours for Black women, and 5.1 hours for Black men. Race-sex differences (p < 0.001) remained after adjustment for socioeconomic, employment, household, and lifestyle factors and for apnea risk. Income was independently associated with sleep latency and efficiency. Sleep duration and quality, which have consequences for health, are strongly associated with race, sex, and socioeconomic status.     

Activities of daily living decrease similarly in hospital-treated patients with a hip fracture or a vertebral fracture: a one-year prospective study in 151 patients

AIMS: A hip fracture is commonly regarded as the most devastating fragility fracture, as regards both morbidity and mortality, while a vertebral fracture is usually regarded as having lower general morbidity. The purpose of this study was to investigate whether hospitalized patients with a hip or a vertebral fracture experience similar functional deterioration following the fracture as regards activity of daily living (ADL) and experienced quality of life (QOL). METHODS: Eighty-seven women and 22 men, mean age 81 (range 66-96), with a hip fracture and 34 women and 8 men, mean age 81 (range 68-92), with a vertebral fracture were followed up for 12 months. ADL before fracture and at 4 and 12 months after the fracture were evaluated as well as QOL at 4 and 12 months after the fracture, by questionnaires. RESULTS: A hip and a vertebral fracture in community dwellers within the same age range confers a similar decrease in ADL during the four months following the fracture. No restoration was seen in ADL or total QOL during the year following the fracture. Patients with a vertebral fracture had a lower QOL than patients with a hip fracture 4 and 12 months after the fracture. CONCLUSION: The need for external community assistance for patients with a vertebral fracture that forces them to have hospital treatment may be similar to the need following a hip fracture.     

Race and sex differences in long-term survival rates for elderly patients with pulmonary embolism.

OBJECTIVES: The goal of this study was to provide estimates of race- and sex-specific survival rates over a 10-year period for a cohort of 49,752 Medicare patients admitted to the hospital in 1984 with a diagnosis of pulmonary embolism. METHODS: Data were derived from Medicare Provider Analysis and Review Record inpatient claims files and the National Death Index file. RESULTS: For a primary diagnosis of pulmonary embolism, median survival times among Black men and women were 2.5 years and 5.2 years, respectively; for White men and women, the median survival times were 4.3 years and 5.9 years, respectively. Median survival times for Black men and women and White men and women with a secondary diagnosis of pulmonary embolism were 0.4 years, 0.7 years, 0.8 years, and 1.4 years, respectively. Survival rates declined with advancing age. CONCLUSIONS: Overall, survival rates among Blacks were lower than those among Whites, and men had lower survival rates than women. These survival estimates provide new insights into outcomes following pulmonary embolism in hospitalized elderly people.     

Fracture risk in the U.S. Medicare population

Using data from the 5% U.S. Medicare sample, we estimated the actuarial (life table) risk that a person aged 65 will fracture the upper or lower limbs or the pelvis, by age 75, 80, 85, and 90, taking into account the chance of dying in the interval. The actuarial risk of a 65-year old white woman sustaining a fracture by age 90 is 16% for the hip, 9% for distal forearm, 5% for proximal humerus, and 4% for ankle. Black women and white men have substantially lower risks, and the risks for black men are very low. Although hip fractures pose the single greatest risk, the risk of all other fractures combined is greater. White women have particularly high risks for all fractures, because of their longevity as well as their high fracture rates. It is important to adjust for the probability of dying when estimating risks in an elderly population.     

Are local health department expenditures related to racial disparities in mortality?

This study estimated whether 1990–1997 changes in expenditures per capita of local health departments (LHDs) and percentage share of local public revenue allocated to LHDs were associated inversely with 1990–1997 changes in mortality rates for Black and White racial/ethnic groups in the US. Population was 883 local jurisdictions with 1990 and 1997 mortality rates for Black and White racial populations from the Centers for Disease Control and Prevention Wonder Compressed Mortality File and LHD expenditures from the National Association of County and City Health Officials. Using a time-trend ecologic design, changes in LHD expenditures per capita and percentage share of public revenue were not related to reductions in Black/White disparities in total, all-cause mortality rates. Increased LHD expenditures or percentage share were associated with reduced Black/White disparities for adults aged 15–44 and males. LHD expenditures or percentage share were related to absolute reductions in mortality for infants, Blacks, and White females but did not close Black–White mortality differences for these groups. Therefore, disparities in Black and White mortality rates for subgroups with the greatest mortality gaps may be more likely to be reduced by public investment in local health departments than disparities in Black and White total, all-cause mortality rates.     

Increased atrial fibrillation mortality: United States, 1980-1998

The authors used death certificate data to evaluate national trends in the reporting of atrial fibrillation as an underlying or contributory cause of death for groups defined by age (45 years or older), sex, and race (Black vs. White) and to examine comorbidity. The multiple-causes mortality files from 1980 through 1998 were analyzed for decedents, with atrial fibrillation (International Classification of Diseases, Ninth Revision, code 427.3) listed as one of up to 20 conditions causing death. The number of decedents with atrial fibrillation increased from 18,947 in 1980 to 61,946 in 1998, and the proportion with atrial fibrillation reported as the underlying cause of death rose from 8.3% in 1980 to 11.6% in 1998. Age-standardized death rates from 1980 to 1998 were consistently highest among White men, followed (in descending order) by White women, Black men, and Black women. Overall, the age-standardized rate (per 100,000) increased from 27.6 in 1980 to 69.8 in 1998 (an average annual increase of 5.4%, p < 0.0001). Ischemic heart disease was the most frequent underlying cause of death among decedents with atrial fibrillation (26.8%). These findings emphasize the need for increased application of proven prevention and control measures to decrease associated cardiovascular morbidity and mortality.     

Out-of-hospital cardiac arrest: racial differences in outcome in Seattle.

OBJECTIVES. Out-of-hospital sudden cardiac arrest is a key area in which to study the dual problem of the poorer health status of minority populations and their poorer access to the health care system. We proposed to examine the relationship between race (Black/White) and survival. METHODS. We determined the incidence and outcome of cardiac arrests in Seattle for which medical assistance was requested. RESULTS. Over a 26-month period, the age-adjusted incidence of out-of-hospital cardiac arrest was twice as great in Blacks than in Whites (3.4 vs 1.6 per 1000 aged 20 and over). The initial resuscitation rate was markedly poorer in the Black victims (17.1% vs 40.7%), and rates of survival to hospital discharge were also lower in Blacks (9.4% vs 17.1%). Both effective initial resuscitation and survival were significantly related to White race following adjustment for other covariates. CONCLUSION. The differences in outcomes were not fully explained by features of the collapse or relevant service factors. Possible explanations include delays in instituting therapy, less bystander-initiated cardiopulmonary resuscitation, poorer levels of health, and differences in the underlying cardiac disorders.     

Differences in Health-Related Quality of Life and Treatment Preferences Among Black and White Patients with End-Stage Renal Disease

BACKGROUND: Relatively little is known about racial differences in health-related quality of life (HRQL) among patients receiving dialysis for end-stage renal disease (ESRD) or how such differences may relate to preferences for renal transplantation. METHODS: We surveyed 1392 patients, ages 18-54 approximately 10 months after they initiated dialysis in 4 regions of the United States. The HRQL measures analyzed were overall health, emotional health, physical activity, energy level, social activity, and effect of ESRD on daily life. We also examined whether the measures of HRQL were associated with patients' preferences for renal transplantation by race. RESULTS: After adjustment for socioeconomic and clinical characteristics, Black women and men reported better overall health than White women and men, respectively. Black women reported higher energy levels than White women, and Black men reported less negative effects of ESRD on daily life compared to White men. Black men with high levels of physical activity were less likely to be certain about preferring a transplant than White men with similar levels of physical activity. CONCLUSIONS: Black patients receiving dialysis reported better HRQL than White patients, even after controlling for potential confounders. Racial differences in preferences for renal transplantation among men may be associated with their levels of physical activity.     

Social class and black-white differences in breast cancer survival

In the United States, Blacks have poorer survival rates than Whites for breast cancer. The root of this difference--social or genetic--is unclear. Utilizing the Western Washington Cancer Surveillance System and 1980 Census block group data, we examined social class and race as predictors of breast cancer survival in 1,506 women during their first 11 years following diagnosis (251 Blacks, 1,255 Whites). In a Cox regression model, after adjustment for Black-White differences in age, stage, and histology, Black mortality was 1.35 times that of Whites (95%CI = 1.05-1.72). Following additional adjustment for social class, as measured by a variety of block group characteristics, Black mortality was only 1.10 times that of Whites (95%CI = 0.83-1.46). In both Blacks and Whites, poorer social class was a powerful determinant of shortened survival. These results indicate that the observed breast cancer survival differences between Black and White women today in the US today is substantially due to the poorer social class standing of Blacks.     

Multiple cause-of-death analysis of hypertension-related mortality in New York State

Multiple cause-of-death data--that is, records of all medical conditions listed on death certificates--are used to study hypertension mortality in New York State during 1968-82. Mortality rates based on underlying causes for ischemic heart disease (IHD) and stroke are selected for comparison. During 1968-78, white women showed the largest age-adjusted decline of all race-sex groups for hypertension, as white men did for stroke and nonwhite men did for IHD. White men showed the largest age-adjusted decline for all three diseases for 1979-82. In general, declines in hypertension death rates are more comparable to declines in stroke mortality than to IHD mortality.