Health and economic impact of hip fracture in Estonia
Date
2017-11-13
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Abstract
Reieluukaela murd vanemas eas on seotud olulise elukvaliteedi languse, liigsuremuse ja kuluga. Arenenud maades saab iga kuues üle 50-aastane naine eluea jooksul reieluukaela murru, kuni 20% haigetest sureb aasta jooksul peale murdu ja murrueelne elukvaliteet taastub vähem kui pooltel haigetest.
Samas on tervisekaotuse hinnangutes veel palju ebaselget. Esmashaigestumus Euroopa riikides varieerub, kuid erinevuse põhjused ei ole lõpuni selged. Reieluukaela murruga seotud kulud suurenevad, kuid andmed tervishoiu- ja sotsiaalteenuste kasutuse kohta on ebapiisavad. Reieluukaela murru epidemioloogilised ja kuluandmed Eestis on puudulikud.
Uurimistöö eesmärk oli reieluukaela murruga seotud tervise- ja majandusmõju hindamine ≥50-aastastel inimestel Eestis 2005-2016 aastal. Hinnati reieluukaela murru avaldumust (ökoloogiline uuring), liigsuremust (rahvastikupõhine retrospektiivne kohortuuring) ja murruhaigete elukvaliteeti, ressursikasutust ja kulusid (prospektiivne kohortuuring). Andmed saadi Eesti Haigekassast, reieluukaela murruga haigete intervjuudest ja Eesti statistika andmebaasist.
Leiti, et reieluukaela murru avaldumus Eesti naistel oli suhteliselt madal, kuid meestel üks Euroopa kõrgematest. Murdude arvu suurenemine vaatlusalusel perioodil oli tingitud rahvastiku vananemisest. Murrujärgne elukvaliteet oli vaid 7% võimalikust ja selle taastumine aeglasem kui paljudes Euroopa riikides. Murrujärgse eriarstiabi ja perearsti teenuse kasutus oli võrreldav Rootsiga, kuid taastusravi, koduõenduse ja sotsiaalabi kasutus väga madal. Seda kompenseeris lähedaste abi, mida kasutas 18 kuu jooksul 80% haigetest. Reieluukaela murru 18 kuu kogukulu oli >8000 eurot haige kohta, mis on võrreldav infarkti ja insuldi kogukuluga.
Samuti leiti, et reieluukaela murd on oluline iseseisev suremuse riskifaktor. Keskmine murrujärgne üldsuremus ühe aasta jooksul oli 28% ehk 20% võrra (3-4 korda) kõrgem kui ilma murruta isikuil, olles võrreldav dementsuse või metastaatilise vähi korral esinevaga. Liigsuremus nooremates vanusrühmades (50-69 aastat) oli Eestis suurem kui lääneriikides. Kaasuvate haiguste mõju reieluukaela murru liigsuremusele on väike ja ei oma liigsuremuse vähendamisel kriitilist rolli. Liigsuremuse vähendamine saab olla võimalik murru ja selle tüsistuste vältimise ning meditsiinilise ja sotsiaalse rehabilitatsiooni parandamisega.
Tulemused võimaldavad reieluukaela murruga seotud summaarse tervisekaotuse hindamist, sihtrühmade määratlemist murruga seotud suremuse vähendamiseks ja informeeritud tervise- ja sotsiaalpoliitiliste otsuste langetamist. Tulemusi saab kasutada ka reieluukaela murru ennetus- ja ravimeetmete kulutõhususe hindamisel. Teadaolevalt on tegemist esimese tervikliku reieluukaela murru tervise- ja majandusmõju hindamisega Kesk- ja Ida-Euroopas.
Hip fracture in older age is associated with significant loss of quality of life, excess mortality, and cost. Every 6-7th woman over 50 years will experience a hip fracture, over 20% of patients die within one year, and less than half of patients recover fully. However, the disease burden of hip fracture is not well established. The incidence among European countries varies, while the reasons for this variability are not certain. Costs are increasing, but the data on health and social care use are insufficient. The epidemiologic and cost data for Estonia are incomplete. The aim of the research was to assess the health and economic impact of hip fracture among individuals aged over 50 years in Estonia in 2005-2016. We estimated the incidence (ecological study), excess mortality (population-based retrospective cohort study), and the loss of quality of life, resource use, and cost (prospective cohort study). The data were collected from the Estonian Health Insurance Fund database, Statistics Estonia, and from patient interviews. The hip fracture incidence in Estonian women was among the lowest, and the rate in men among the highest in Europe. The increasing number of fractures over the period of observation was a result of population aging. Patient’s quality of life after a fracture was only 7%, and the recovery was slower than in many other European countries. Fracture-related specialty and primary care use was comparable to that in Sweden, but the use of rehabilitation, home nursing, and social care was very low. The shortfall may explain the high use of informal care. The hip fracture related societal cost during 18 months was >8000 euros per patient, comparable to that for myocardial infarction or stroke. Hip fracture is a strong independent risk factor for death. The aggregated risk of all-cause death at 1 year after fracture was 28%, being 20% or 3-4 times higher than that without fracture, comparable to that for dementia and cancer. The excess mortality in younger (50-69 years) patients in Estonia was higher than in the Western countries. The impact of comorbidities on excess mortality was modest. Hip-fracture related deaths could be avoided by preventing fractures and their complications and by improving post-fracture care. These findings should help to estimate the total societal burden of hip fracture, define target groups for reducing mortality after hip fracture, and inform the related health and social policy. The results may also be used in economic evaluations for selecting cost-effective interventions for hip fracture prevention and care. To our knowledge, this is the first comprehensive estimation of hip fracture health and economic impact in Central and Eastern Europe.
Hip fracture in older age is associated with significant loss of quality of life, excess mortality, and cost. Every 6-7th woman over 50 years will experience a hip fracture, over 20% of patients die within one year, and less than half of patients recover fully. However, the disease burden of hip fracture is not well established. The incidence among European countries varies, while the reasons for this variability are not certain. Costs are increasing, but the data on health and social care use are insufficient. The epidemiologic and cost data for Estonia are incomplete. The aim of the research was to assess the health and economic impact of hip fracture among individuals aged over 50 years in Estonia in 2005-2016. We estimated the incidence (ecological study), excess mortality (population-based retrospective cohort study), and the loss of quality of life, resource use, and cost (prospective cohort study). The data were collected from the Estonian Health Insurance Fund database, Statistics Estonia, and from patient interviews. The hip fracture incidence in Estonian women was among the lowest, and the rate in men among the highest in Europe. The increasing number of fractures over the period of observation was a result of population aging. Patient’s quality of life after a fracture was only 7%, and the recovery was slower than in many other European countries. Fracture-related specialty and primary care use was comparable to that in Sweden, but the use of rehabilitation, home nursing, and social care was very low. The shortfall may explain the high use of informal care. The hip fracture related societal cost during 18 months was >8000 euros per patient, comparable to that for myocardial infarction or stroke. Hip fracture is a strong independent risk factor for death. The aggregated risk of all-cause death at 1 year after fracture was 28%, being 20% or 3-4 times higher than that without fracture, comparable to that for dementia and cancer. The excess mortality in younger (50-69 years) patients in Estonia was higher than in the Western countries. The impact of comorbidities on excess mortality was modest. Hip-fracture related deaths could be avoided by preventing fractures and their complications and by improving post-fracture care. These findings should help to estimate the total societal burden of hip fracture, define target groups for reducing mortality after hip fracture, and inform the related health and social policy. The results may also be used in economic evaluations for selecting cost-effective interventions for hip fracture prevention and care. To our knowledge, this is the first comprehensive estimation of hip fracture health and economic impact in Central and Eastern Europe.
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Keywords
reieluukael, luumurrud, tervisemõju analüüs, majanduslikud mõjud, haiguskoormus, elukvaliteet, kaasnevad haigused, suremus, liigsuremus, rahvatervis, Eesti, 21. saj. algus, femoral neck, bone fractures, health impact assessment, economic effects, burden of disease, quality of life, comorbidities, mortality, excess mortality, public health, Estonia, beginning of the 21st century