A secular trend in hip fracture incidence in East Germany

The central Inpatient Register of the former German Democratic Republic was used to study the population-based epidemiology of hip fractures among 16. 5 million East Germans. Incidence rates for hospital discharges for proxima l femoral fractures for the age group 60 years and over were calculated for the years 1971 to 1989, the year before unification. Incidence rates for 1 989 are similar to figures reported from the UK and The Netherlands, but lo wer than Scandinavian rates. A decrease in the admission rate was noted fro m 1971 to 1974 of 4.5% each year on average, and an increase from 1974 onwa rds of 4.4% on average. This change was observed to a different extent in a ll age groups. The female:male ratio of the standardized discharge incidenc e was stable at 2.3:1 and the female:male ratio of manifest cases increases from 4.1:1 in 1971 to 5.1:1 in 1989. An exponential increase in the incide nce rates was observed with age. This apparent rate overestimates both the rate for true incident cases (by about 25-30%. if adjustments are made for readmissions and transfers) and their trend. Adjusted estimates for inciden t fractures show an increase of 2% annually. Cohort effects due to changed selective forces appear to be one reasonable causal explanation.