Abstract:
AIM Femoral fracture constitutes a major public health problem associated with older population in New Zealand, and there is a real need to examine critical contributing factors that could influence its occurrence. This study describes national trends in femoral fracture rates among older adults between 2000/2001 and 2011/2012, and examines its association with potential risk factors including exercise intervention for preventing fractures and the Canterbury earthquakes (magnitude 6.0 and greater). METHODS An observational study was conducted using individual hospital stay records in the National Minimum Dataset (2001-2013). Generalized linear regression models were used to assess the annual trend and potential impact of contributing factors on the number of hospital admissions for femoral fracture. Patients’ demographics (age and gender) and geograhic locations (DHB) were adjusted in all analyses, as well as time and seasonal trends. Results were reported as relative risk (RR) with associated 95% confidence interval (CI) and twosided p-values. FINDINGS Overall, average percentage decrease in femoral fracture rates was 1.5% (95% CI 1.2%-1.8%, p-value < 0.0001) per year between 2000/2001 and 2011/2012. There was no significant impact of exercise intervention in reducing the fracture rates at the population level (RR 0.99, 95% CI 0.97-1.02, p-value = 0.54). Among older population in Canterbury, the immediate impact of four major eathquakes could be as high as a RR of 3.1 (95% CI 2.3-4.4, p-value < 0.0001) and the effect maintained up to 10 weeks post earthquake. CONCLUSIONS The impact of exercise programmes on a population, even if well proven in randomised trials, was not apparent in our study. Further research is needed to understand mechasisms responsible for the declining rates, as femoral farctures continue to be a problem with significant consequences for health care system and individuals. The impact of strong earthquakes on rates of femoral fracture are high and continue over 10 weeks after the last major earthquake. This shows how physical changes to the landscape after a disaster can have detrimental effect on the residents.