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. 2016 Sep 1;17(9):865.e1-3.
doi: 10.1016/j.jamda.2016.06.012. Epub 2016 Jul 25.

Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents

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Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents

Geetanjoli Banerjee et al. J Am Med Dir Assoc. .
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Introduction: Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents.

Design and setting: Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases.

Participants: A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old.

Measurements: Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010.

Results: The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest.

Conclusions: We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation.

Keywords: Hip fracture; Medicare; geographic variation; long-term care; nursing home.

Conflict of interest statement

The authors declare no conflicts of interest.


Fig. 1
Fig. 1
Age-, sex-, and race-adjusted hip fracture incidence rates per 100 person-years by state, 2007–2010.
Fig. 2
Fig. 2
Variation of age-, sex-, and race-adjusted hip fracture incidence rate by 100 person-years by Census Division, 2007–2010. Diamonds represent the means. Vertical lines represent the medians. Blue boxes represent interquartile ranges. Whiskers represent minimum and maximum. US Census Divisions: Pacific: WA, OR, CA, AK, HI (n = 1622 NH facilities). South Atlantic: DE, MD, DC, WV, VA, NC, SC, GA, FL (n = 2293 NH facilities). Middle Atlantic: NY, NJ, PA (n = 349 NH facilities). New England: ME, NH, VT, MA, RI, CT (n = 981 NH facilities). East South Central: KY, TN, MS, AL (n = 1011 NH facilities). East North Central: MI, WI, IL, IN, OH (n = 3002 NH facilities). West North Central: MN, ND, SD, NE, IA, MO, KS (n = 2070 NH facilities). West South Central: AR, OK, LA, TX (n = 1928 NH facilities). Mountain: MY, WY, ID, CO, UT, NV, NM, AZ (n = 732 NH facilities).

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