Current Trends in Comorbidity Prevalence and Associated Mortality in a Population-Based Cohort of Hip Fracture Patients in Denmark

Figures & data

Table 1 Baseline Characteristics for Patients with Hip Fracture According to Comorbidity Level Measured with Charlson Comorbidity, Elixhauser, and RxRisk Indices

	Charlson Comorbidity Index				Elixhauser Index				RxRisk Index
	No 0 Points	Moderate 1 Point	Severe 2 Points	Very Severe ≥3 Points	No ≤0 Points	Moderate 1–5 Points	Severe 6–13 Points	Very Severe ≥14 Points	No ≤0 Points	Moderate 1–3 Points	Severe 4–6 Points	Very Severe ≥7 Points
Age, (n)
65–74 years	23% (2750)	19% (1398)	20% (1129)	22% (1438)	23% (3204)	18% (1426)	21% (1398)	23% (687)	25% (2223)	20% (1930)	19% (1283)	21% (1279)
75–84 years	34% (3980)	37% (2667)	37% (2107)	40% (2672)	35% (4868)	36% (2772)	38% (2593)	41% (1193)	36% (3166)	35% (3369)	37% (2497)	39% (2394)
≥85 years	43% (5132)	44% (3236)	43% (2417)	38% (2517)	42% (5879)	46% (3563)	41% (2809)	36% (1051)	39% (3444)	46% (4454)	44% (2995)	40% (2409)
Sex, (n)
Male	25% (2940)	29% (2130)	33% (1881)	40% (2679)	25% (3490)	31% (2384)	37% (2494)	43% (1262)	29% (2525)	31% (2979)	32% (2152)	33% (1974)
Female	75% (8922)	71% (5171)	67% (3772)	60% (3948)	75% (10,461)	69% (5377)	63% (4306)	57% (1669)	71% (6308)	70% (6774)	68% (4623)	6% (4108)
Fracture, (n)
Medial fracture	55% (26,083)	54% (28,087)	55% (28,877)	54% (28,376)	56% (25,246)	54% (27,846)	53% (28,262)	53% (30,069)	56% (27,526)	53% (26,859)	54% (28,344)	55% (28,694)
Lateral fracture	45% (5360)	46% (3356)	45% (2566)	46% (3067)	44% (6197)	46% (3597)	47% (3181)	47% (1374)	44% (3917)	47% (4584)	46% (3099)	45% (2749)
Cohabitant, (n)
Living alone	61% (7283)	65% (4737)	63% (3547)	58% (3819)	61% (8548)	64% (4967)	61% (4134)	59% (1737)	58% (5100)	62% (6043)	63% (4298)	65% (3945)
Living together	39% (4579)	35% (2564)	37% (2106)	42% (2808)	39% (5403)	36% (2794)	39% (2666)	41% (1194)	42% (3733)	38% (3710)	37% (2477)	35% (2137)

Table 2 Prevalence of Individual Diseases Measured with the Different Indices

	Charlson Comorbidity Index	Elixhauser Index	Rx-Risk Index
Chronic pulmonary disease	14%	14%	17%^a
Congestive heart failure	8%	9%	13%
Uncomplicated diabetes	10%	10%	12%^b
Renal disease	6%	4%	0%
Liver disease	1%	2%	3%
Malignancies	17%	13%	0%
HIV/AIDS	0%	0%	0%
Metastatic cancer	2%	2%	–
Complicated diabetes	2%	6%	–
Peptic ulcer disease	5%	2%	–
Rheumatological disease	5%	5%	–
Paraplegia/hemiplegia	0%	0%	–
Peripheral vascular disease	9%	9%	–
Dementia	11%	–	9%
Cardiac arrhythmias	–	21%	6%
Hypertension	–	37%	39%
Hypothyroidism	–	3%	7%
Alcohol abuse	–	4%	1%
Depression	–	6%	29%
Moderate and severe liver disease	1%	1%	–
Cerebrovascular disease	18%	–	–
Myocardial infarction	5%	–	–
Leukemia	1%	–	–
Lymphoma	1%	1%	–
Coagulopathy	–	1%	–
Fluid and electrolyte disorders	–	15%	–
Valvular disease	–	7%	–
Other neurological disorders	–	6%	–
Weight loss	–	3%	–
Deficiency anemia	–	3%	–
Obesity	–	2%	–
Drug abuse	–	0%	–
Blood loss anemia	–	1%	–
Psychosis	–	1%	–
Ischaemic heart disease hypertension	–	–	42%
Antiplatelets	–	–	37%
Hyperlipidaemia	–	–	33%
Pain	–	–	32%
Gastroesophageal reflux disease	–	–	31%
Anticoagulants	–	–	16%
Inflammation/pain	–	–	15%
Osteoporosis	–	–	13%
Anxiety	–	–	10%
Steroid-responsive disease	–	–	10%
Allergies	–	–	9%
Epilepsy	–	–	9%
Psychotic illness	–	–	8%
Ischaemic heart disease angina	–	–	7%
Parkinson´s disease	–	–	5%
Benign prostatic hyperplasia	–	–	5%
Incontinence	–	–	5%
Gout	–	–	4%
Irritable bowel syndrome	–	–	1%
Smoking cessation	–	–	1%
Pancreatic insufficiency	–	–	0%
Psoriasis	–	–	0%
Pulmonary hypertension	–	–	0%
Transplant	–	–	0%
Tuberculosis	–	–	0%
Bipolar disorder	–	–	0%
Glaucoma	–	–	0%
Hepatitis B	–	–	0%
Hepatitis C	–	–	0%
Hyperkalaemia	–	–	0%
Hyperthyroidism	–	–	0%
Malnutrition	–	–	0%
Migraine	–	–	0%

Notes: ^aChronic airways disease. ^bDiabetes overall.

Figure 1 The disease areas included in the three indices.

Figure 2 (A–C) Concordance between two indices categorisation of comorbidity level.

Figure 3 (A–C) Proportion of comorbidity level over calendar year.

Table 3 Crude and Adjusted 30-Day and One-Year Mortality According to Comorbidity Level Among Patients with Hip Fractures

	30-Day Mortality			One-Year Mortality
	30-Day Mortality, % (Patients, n/ Patients at Risk, N)	Unadjusted OR (95% CI)	Adjusted^a OR (95% CI)	One-Year Mortality, % (Patients, n / Patients at Risk, N)	Unadjusted HR^b (95% CI)	Adjusted^a HR (95% CI)
Charlson comorbidity Index
No comorbidity: 0 points	6.5 (775/11,862)	1.00 (reference)	1.00 (reference)	17.8 (2106/11,862)	1.00 (reference)	1.00 (reference)
Moderate comorbidity: 1 point	10.6 (774/7301)	1.70 (1.5–1.9)	1.69 (1.5–1.9)	27.4 (2003/7301)	1.64 (1.5–1.7)	1.63 (1.5–1.7)
Severe comorbidity: 2 points	11.1 (628/5653)	1.79 (1.6–2.0)	1.76 (1.6–2.0)	29.9 (1692/5653)	1.82 (1.7–1.9)	1.79 (1.7–1.9)
Very severe comorbidity: ≥3 points	15.1 (1000/6627)	2.54 (2.3–2.8)	2.64 (2.4–2.9)	38.7 (2565/6627)	2.5 (2.4–2.6)	2.54 (2.4–2.7)
Elixhauser Index
No comorbidity: ≤0 point	7.1 (985/13,951)	1.00 (reference)	1.00 (reference)	19.2 (2682/13,951)	1.00 (reference)	1.00 (reference)
Moderate comorbidity: 1–5 points	10.4 (807/7761)	1.53 (1.4–1.7)	1.41 (1.3–1.6)	27.9 (2166/7761)	1.54 (1.5–1.6)	1.43 (1.4–1.5)
Severe comorbidity: 6–13 points	13.1 (888/6800)	1.98 (1.8–2.2)	1.90 (1.7–2.1)	32.5 (2208/6800)	1.85 (1.8–2.0)	1.79 (1.7–1.9)
Very severe comorbidity: ≥14 points	17.0 (497/2931)	2.69 (2.4–3.0)	2.74 (2.4–3.1)	44.7 (1310/2931)	2.76 (2.6–3.0)	2.75 (2.6–2.9)
Rx-Risk Index
No comorbidity: ≤0 point	6.0 (534/8833)	1.00 (reference)	1.00 (reference)	16.5 (1457/8833)	1.00 (reference)	1.00 (reference)
Moderate comorbidity: 1–3 points	9.1 (885/9753)	1.55 (1.4–1.7)	1.41 (1.3–1.6)	24.6 (2404/9753)	1.56 (1.5–1.7)	1.44 (1.4–1.5)
Severe comorbidity: 4–6 points	11.6 (788/6775)	2.05 (1.8–2.3)	1.92 (1.7–2.2)	30.8 (2089/6775)	2.04 (1.9–2.2)	1.91 (1.8–2.0)
Very severe comorbidity: ≥7 points	15.9 (970/6082)	2.95 (2.6–3.3)	3.06 (2.7–3.4)	39.7 (2416/6082)	2.80 (2.6–3.0)	2.82 (2.6–3.0)

Notes: ^aAdjusted for age and sex. ^bHazard Ratio.

Abbreviation: OR, Odds Ratio.

Figure 4 (A-B) Forest plots of adjusted associations between comorbidity level and mortality.