The impact of aaee and fractures on mortality in a postmenopausal medicaidpopulation

The purpose of this study was to model Fractures and survival by age and ra ce in a large postmenopausal Medicaid population. All Georgia Medicaid clai ms were abstracted for the years 1992, 1993, and 1994. Claims for postmenop ausal women (greater than or equal to 50 years of age) were retained, and p atients with fractures were identified by International Classificafion of D iseases, Ninth Revision codes for fracture. A survival analysis was conduct ed using Kaplan-Meier estimators to evaluate the effect of fracture, age, a nd race on 3-year-survival. A total of 159,400 white and black postmenopaus al women were identified. The cohort with fracture totaled 5933 patients, w ith femoral fractures constituting 46% of all fractures. Discounting those with fracture before the study, the fracture incidence was similar to 1.2% in this postmenopausal female cohort. The survival analysis suggested that after age was accounted for, black post-menopausal women had a 42% increase d risk of death within 3 years of fracture, compared with 13% for white wom en. However, postmenopausal black women were similar to 50% less likely to experience a fracture, and postmenopausal black Women without fracture had better survival rates than comparable white women. Mortality crossover and the diminished likelihood of fracture mask the true nature of fracture surv ival in postmenopausal black women. Postmenopausal black women with fractur e are at greater risk of dying than their white counterparts.