Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium
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Published version
Author(s)
Type
Journal Article
Abstract
Background No studies have estimated disability-adjusted life-years (DALYs) lost due to hip fractures using real-life
follow-up cohort data. We aimed to quantify the burden of disease due to incident hip fracture using DALYs in
prospective cohorts in the CHANCES consortium, and to calculate population attributable fractions based on DALYs
for specific risk factors.
Methods We used data from six cohorts of participants aged 50 years or older at recruitment to calculate DALYs. We
applied disability weights proposed by the National Osteoporosis Foundation and did a series of sensitivity analyses to
examine the robustness of DALY estimates. We calculated population attributable fractions for smoking, body-mass
index (BMI), physical activity, alcohol intake, type 2 diabetes and parity, use of hormone replacement therapy, and oral
contraceptives in women. We calculated summary risk estimates across cohorts with pooled analysis and randomeffects
meta-analysis methods.
Findings 223 880 men and women were followed up for a mean of 13 years (SD 6). 7724 (3·5%) participants developed
an incident hip fracture, of whom 413 (5·3%) died as a result. 5964 DALYs (27 per 1000 individuals) were lost due to
hip fractures, 1230 (20·6%) of which were in the group aged 75–79 years. 4150 (69·6%) DALYs were attributed to
disability. Current smoking was the risk factor responsible for the greatest hip fracture burden (7·5%, 95% CI
5·2–9·7) followed by physical inactivity (5·5%, 2·1–8·5), history of diabetes (2·8%, 2·1–4·0), and low to average BMI
(2·0%, 1·4–2·7), whereas low alcohol consumption (0·01–2·5 g per day) and high BMI had a protective effect.
Interpretation Hip fracture can lead to a substantial loss of healthy life-years in elderly people. National public health
policies should be strengthened to reduce hip fracture incidence and mortality. Primary prevention measures should
be strengthened to prevent falls, and reduce smoking and a sedentary lifestyle.
follow-up cohort data. We aimed to quantify the burden of disease due to incident hip fracture using DALYs in
prospective cohorts in the CHANCES consortium, and to calculate population attributable fractions based on DALYs
for specific risk factors.
Methods We used data from six cohorts of participants aged 50 years or older at recruitment to calculate DALYs. We
applied disability weights proposed by the National Osteoporosis Foundation and did a series of sensitivity analyses to
examine the robustness of DALY estimates. We calculated population attributable fractions for smoking, body-mass
index (BMI), physical activity, alcohol intake, type 2 diabetes and parity, use of hormone replacement therapy, and oral
contraceptives in women. We calculated summary risk estimates across cohorts with pooled analysis and randomeffects
meta-analysis methods.
Findings 223 880 men and women were followed up for a mean of 13 years (SD 6). 7724 (3·5%) participants developed
an incident hip fracture, of whom 413 (5·3%) died as a result. 5964 DALYs (27 per 1000 individuals) were lost due to
hip fractures, 1230 (20·6%) of which were in the group aged 75–79 years. 4150 (69·6%) DALYs were attributed to
disability. Current smoking was the risk factor responsible for the greatest hip fracture burden (7·5%, 95% CI
5·2–9·7) followed by physical inactivity (5·5%, 2·1–8·5), history of diabetes (2·8%, 2·1–4·0), and low to average BMI
(2·0%, 1·4–2·7), whereas low alcohol consumption (0·01–2·5 g per day) and high BMI had a protective effect.
Interpretation Hip fracture can lead to a substantial loss of healthy life-years in elderly people. National public health
policies should be strengthened to reduce hip fracture incidence and mortality. Primary prevention measures should
be strengthened to prevent falls, and reduce smoking and a sedentary lifestyle.
Date Issued
2017-04-11
Date Acceptance
2017-02-22
Citation
Lancet Public Health, 2017, 2 (5), pp.e239-e246
ISSN
2468-2667
Publisher
Elsevier
Start Page
e239
End Page
e246
Journal / Book Title
Lancet Public Health
Volume
2
Issue
5
Copyright Statement
© The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license
Publication Status
Published