Economic implications of hip fracture: Health service use, institutional care and cost in Canada

As the burden of illness associated with hip fracture extends beyond the in itial hospitalization, a longitudinal 1 year cohort study was used to analy ze levels of health service use, institutional care and their associated co sts, and to examine patient and residency factors contributing to overall 1 year cost. Patients in the study were aged 50 year and over, and had been admitted to an acute care facility for hip fracture in the Hamilton-Wentwor th region of Canada from 1 April 1995 to 31 March 1996. Health care resourc es assessed included initial hospitalization, rehospitalization, rehabilita tion, chronic care, home care, long-term care (LTC) and informal care. Regr ession analysis was used to determine the effects of age, gender, residence , survival and days of follow-up on 1 year cost. The mean 1 year cost of hi p fracture for the 504 study patients was 26 527 Canadian dollars (95% Cl: $24 564-$28 490). One year costs were significantly different for patients who returned to the community ($21 385), versus those who were transferred to ($44 156), or readmitted to LTC facilities ($33 729) (p <0.001). Initial hospitalization represented 58% of 1 year cost for community-dwelling pati ents, compared with 27% for LTC residents. Only 59.4% of community-dwelling patients resided in the community 1 year following hip fracture, and 5.6% of patients who survived their first fracture experienced a subsequent hip fracture. Linear regression indicated place of residence, age and survival were all important contributors to 1 year cost (p<0.001). While the average 1 year cost of care was $26 527; the overall cost varied depending on a pa tient's place of residence, age, and survival to 1 year. Annual economic im plications of hip fracture in Canada are $650 million and are expected to r ise to $2.4 billion by 2041.