Hospitalised osteoporotic vertebral fractures in Spain: Analysis of the national hospital discharge registry

Springer Science and Business Media LLC - Tập 18 - Trang 649-657 - 2007
C. Bouza1,2, T. López1, M. Palma1, J. M. Amate1
1Agency for Health Technology Assessment, Ministry of Health and Consumer Affairs, Madrid, Spain
2Agency for Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain

Tóm tắt

This population-based study reveals clinical and epidemiologic characteristics of hospitalised osteoporosis-related vertebral fractures and indicates an association with a substantial hospital burden in Spain. These data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements. Vertebral fractures (VF) are recognised as the most frequent complication of osteoporosis. Our objective was to determine the clinico-epidemiological characteristics and health-care burden of hospitalised VF in Spain. From the 2002 National Hospital Discharge Register, records for all osteoporosis-related VF in the Spanish population aged ≥30 years and over were retrieved. Diagnostic categories included the ICD-9-CM codes 805 and 733.xx. Population data were drawn from the National Statistics Institute. In total, 7,100 records were eligible for analysis. According to Deyo-adapted Charlson index, 62% of cases had no associated comorbidity. VF were the cause of hospitalisation in 52% of cases. Overall in-hospital mortality was 3.5%. Men had higher adjusted mortality than women. Mean hospital stay was 11.4±0.2 days. Identified cases amounted to a hospitalisation rate of 2.76 cases per 10,000 population aged ≥30 years. Direct inpatient hospital costs exceeded €41million and accounted for 0.078% of Spanish expenditure on hospitalisations and specialised care in 2002. The national discharge database reveals epidemiological features of hospitalised osteoporosis-attributable VF and indicates an association with a substantial hospital burden in Spain. Our data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements.

Tài liệu tham khảo

European Commission. Directorate-General for Employment, Industrial Relations and Social Affairs. Directorate V/F.2 (1998) Report on Osteoporosis in the European Community. Action for prevention. http://www.osteofound.org/publications/pdf/eu_report_98.pdf Cooper C, Melton LJ III (1992) Vertebral fractures: how large is the silent epidemic? BMJ 304:793–794 The European Prospective Osteoporosis Study (EPOS) Group (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS) J Bone Miner Res 17:716–724 Naves Diaz M, Diaz Lopez JB, Gomez Alonso C et al (2000) Study of incidence of osteoporotic fractures in a cohort of individuals older than 50 years from Asturias, Spain, after a 6 year follow-up period. Med Clin 115:650–653 Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13:S27–S31 Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220 Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005 Naves M, Diaz-Lopez JB, Gomez C et al (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–524 Cockerill W, Lunt M, Silman AJ et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119 O’Neill TW, Cockerill W, Matthis C et al (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15:760–765 Melton LJ 3rd, Thamer M, Ray NF et al (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23 Gehlbach SH, Bigelow C, Heimisdottir M et al (2000) Recognition of vertebral fractures in a clinical setting. Osteoporos Int 11:577–582 Jacobsen SJ, Cooper C, Gottlieb MS et al (1992) Hospitalization with vertebral fracture among the aged: a national population based study, 1986–1989. Epidemiology 3:515–518 Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of National Register Sources. Osteoporos Int 7:138–144 Johnell O (2003) Economic implication of osteoporotic spine disease: cost to society. Eur Spine J 12:S168–S169 Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16:S8–S17 Puffer S, Torgerson DJ, Sykes D et al (2004) Health care costs of women with symptomatic vertebral fractures. Bone 35:383–386 Johnell O, Kanis JA, Jonsson B et al (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16:222–228 Roos LL, Fedson DS, Roberts JD et al (1996) Reminding and monitoring: new uses of administrative data for preventive care. Health Manage Forum 9:30–36 Robinson JR, Young TK, Roos LL et al (1997) Estimating the burden of disease. Comparing administrative data and self-reports. Med Care 35:932–947 Charlson ME, Pompei P, Ales S et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383 Deyo RA,Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619 Librero J, Peiró S, Ordiñana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality and readmission at 30 and 365 days. J Clin Epidemiol 52:171–179 Health Information Institute. Ministry of Health and Consumer Affairs. (Accessed:10-05-2006) http://www.msc.es/Diseno/sns/sns_sistemas_informacion.htm Papaioannou A, Watts NB, Kendler DL et al (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228 Melton LJI (1997) Epidemiology of spinal osteoporosis. Spine 22:S2–S11 Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141 Ettinger B, Black DM, Nevitt MC et al (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456 Delmas PD, van de Langerijt L, Watts NB et al (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563 Jalava T, Sarna S, Pylkkanen L et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1259 Ensrud KE, Thompson DE, Cauley JA et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48:241–249 Kanis JA, Oden A, Johnell O et al (2004) Excess mortality after hospitalisation for vertebral fractures. Osteoporos Int 15:108–112 Papaioannou A, Adachi JD, Parkinson W et al (2001) Lengthy hospitalization associated with vertebral fractures despite control for comorbid conditions. Osteoporos Int 12:870–874 Kanis JA, Johnell O, Oden A et al (2002) Intervention thresholds for Osteoporosis. Bone 31:26–31 Kanis JA, Johnell O, Oden A et al (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26 Ray NF, Chan JK, Thamer M et al (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35 Gabriel SE, Tosteson AN, Leibson CL et al (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330 Borgstrom F, Zethraeus N, Johnell O et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17:637–650 Schwenkglenks M, Lippuner K, Hauselmann HJ et al (2005) A model of osteoporosis impact in Switzerland 2000–2020. Osteoporos Int 16:659–671 Ley Orgánica 15/1999 de 13 de Diciembre de Protección de Datos de Carácter personal. Boletín Oficial del Estado n° 298, de 14-12-1999, pp 43088–43099 Ley 41/2002, de 14 noviembre, ley básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. Boletín Oficial del Estado n° 274, de 15-11-2002, pp 40126–40132. Accessible at http://www.msc.es Wilchesky M, Tamblyn RM, Huang A (2004) Validation of diagnostic codes within medical services claims. J Clin Epidemiol 57:131–141 Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532 O’Neill TW, Marsden D, Matthis C et al (1995) Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis. J Epidemiol Community Health 49:87–93