Rural Residential Status Does Not Impact 1-Year Mortality Rates Following Proximal Femur Fracture Fixation
DOI:
https://doi.org/10.32469/pj4gmj18Keywords:
orthopaedic fractures, proximal femur fractures, rural geriatric residents, mortality ratesAbstract
Purpose: To investigate the relationship between rural residential status and 1-year all-cause mortality rates in geriatric patients following operative fixation of proximal femur fractures.
Methods: A retrospective review was conducted on geriatric patients (≥65 years old) presenting with proximal femur fractures at a midwestern Level 1 trauma center between Jan. 1, 2019, to Jan. 1, 2023. Patient demographics, fracture classification, socioeconomic status (National Area Deprivation Index [ADI] quartile), and residential status (Rural Urban Commuting Area [RUCA]) were collected. Patients were categorized by ADI quartiles and RUCA scores to assess socioeconomic and residential impacts on outcomes.
Results: Of the 605 patients, 505 (83.5%) survived past 1 year. Patients who died within 1 year were significantly older (90.6 ± 8.1 years), more likely to be female, and had shorter hospital stays (6.2 ± 5.6 days) compared to survivors (79.8 ± 8.9 years, 7.2 ± 5.6 days). Socioeconomic deprivation residential status and rural status were not significantly associated with 1-year mortality rates. There were no significant differences in outcomes based on race, insurance status, or tobacco use.
Conclusions: The study found no significant difference in 1-year all-cause mortality rates between rural and urban geriatric patients following operative fixation of proximal femur fractures. Contrary to previous findings, higher ADI scores and rural residence were not associated with increased mortality.
References
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573-1579. doi:10.1001/jama.2009.1462
Esper GW, Meltzer-Bruhn AT, Herbosa CG, Ganta A, Egol KA, Konda SR. Defining characteristics of middle-aged and geriatric orthopedic trauma in New York City over a 7-year period. Arch Gerontol Geriatr. 2023;112:105039. doi:10.1016/j.archger.2023.105039
Keller JM, Sciadini MF, Sinclair E, O’Toole RV. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma. 2012;26:e161-165. doi:10.1097/BOT.0b013e3182324460
Shin ED, Sandhu KP, Wiseley BR, et al. Mortality rates after nonoperative geriatric hip fracture treatment: A matched cohort analysis. J Orthop Trauma. 2023;37:237-242. doi:10.1097/BOT.0000000000002549
Frenkel Rutenberg T, Assaly A, Vitenberg M, et al. Outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population. Injury. 2019;50:1347-1352. doi:10.1016/j.injury.2019.05.022
de Haan E, Roukema GR, van Rijckevorsel VAJIM, Kuijper TM, de Jong L, Dutch Hip Fracture Registry Collaboration. Risk factors for 30-days mortality after proximal femoral fracture surgery, a cohort study. Clin Interv Aging. 2024;19:539-549. doi:10.2147/CIA.S441280
Postler A, Posten C, Schubert M, et al. Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital. BMC Geriatr. 2024;24:130. doi:10.1186/s12877-024-04733-8
Baghdadi S, Kiyani M, Kalantar SH, et al. Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors. BMC Musculoskelet Disord. 2023;24:693. doi:10.1186/s12891-023-06825-9
Bzovsky S, Comeau-Gauthier M, Schemitsch EH, et al. Factors associated with mortality after surgical management of femoral neck fractures. J Orthop Trauma. 2020;34 Suppl 3:S15-S21. doi:10.1097/BOT.0000000000001937
Maroko AR. Integrating social determinants of health with treatment and prevention: a new tool to assess local area deprivation. Prev Chronic Dis. 2016;13. doi:10.5888/pcd13.160221
Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int. 2016;27:2727-2737. doi:10.1007/s00198-016-3608-5
Reyes C, García-Gil M, Elorza JM, et al. Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study. Bone. 2015;73:127-131. doi:10.1016/j.bone.2014.12.019
Planey AM, Thomas SR, Friedman H, Hecht HK, Kent E, Holmes GM. Rural hospital closures: A scoping review of studies published between 1990 and 2020. J Health Care Poor Underserved. 2024;35:439-464.
USDA ERS - Rural-Urban Commuting Area Codes. Accessed October 16, 2022. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx
Miller BJ, Cai X, Cram P. Mortality rates are similar after hip fractures for rural and urban patients. Clin Orthop Relat Res. 2012;470:1763-1770. doi:10.1007/s11999-011-2140-3
Thomas HM, Jarman MP, Mortensen S, et al. The role of geographic disparities in outcomes after orthopaedic trauma surgery. Injury. 2023;54:453-460. doi:10.1016/j.injury.2022.11.022
Thoors O, Mellner C, Hedström M. Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age. Acta Orthop. 92:292-296. doi:10.1080/17453674.2021.1876996
Liu E, Killington M, Cameron ID, Li R, Kurrle S, Crotty M. Life expectancy of older people living in aged care facilities after a hip fracture. Sci Rep. 2021;11:20266. doi:10.1038/s41598-021-99685-z
Bajracharya R, Guralnik JM, Shardell MD, et al. Long-term sex differences in all-cause and infection-specific mortality post hip fracture. J Am Geriatr Soc. 2022;70:2107-2114. doi:10.1111/jgs.17800
Ceolin C, Bano G, Biz C, et al. Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences. Aging Clin Exp Res. 2023;35:1063-1071. doi:10.1007/s40520-023-02378-y
Lund CA, Møller AM, Wetterslev J, Lundstrøm LH. Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery. PLoS One. 2014;9:e99308. doi:10.1371/journal.pone.0099308
Ferris H, Merron G, Coughlan T. 1 year mortality after hip fracture in an Irish urban trauma centre. BMC Musculoskelet Disord. 2023;24:487. doi:10.1186/s12891-023-06605-5
Ariza-Vega P, Kristensen MT, Martín-Martín L, Jiménez-Moleón JJ. Predictors of long-term mortality in older people with hip fracture. Arch Phys Med Rehabil. 2015;96:1215-1221. doi:10.1016/j.apmr.2015.01.023
Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop. 2014;85:54-59. doi:10.3109/17453674.2013.878831
Huette P, Abou-Arab O, Djebara AE, et al. Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study. Sci Rep. 2020;10:9607. doi:10.1038/s41598-020-66614-5
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ashwin Garlapaty, Alaina Bryson, Drew Kasten, Harjeev Singh, Kylee Rucinski, Brett Crist
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
