Rural, urban, and teaching hospital differences in hip fracture mortality

Brendan J Farley; Brian M Shear; Vivian Lu; Kyla Walworth; Kevin Gray; Matt Kirsch; John M Clements

doi:10.1016/j.jor.2020.08.039

Rural, urban, and teaching hospital differences in hip fracture mortality

J Orthop. 2020 Sep 6:21:453-458. doi: 10.1016/j.jor.2020.08.039. eCollection 2020 Sep-Oct.

Authors

Brendan J Farley¹, Brian M Shear¹, Vivian Lu¹, Kyla Walworth¹, Kevin Gray¹, Matt Kirsch¹, John M Clements^{1

2}

Affiliations

¹ Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA.
² Michigan State University, College of Human Medicine, Division of Public Health, Flint, MI, USA.

Abstract

Introduction: Hip fractures remain one of the most prevalent and deadly conditions afflicting those 65 years and older. For other health conditions (e.g. myocardial infarction), hospital location is associated with poorer health outcomes. To our knowledge, no study has investigated the relationship between hip fracture morality rate in the United States between urban and rural hospital settings.

Methods: A retrospective cohort study was conducted to examine differences in in-hospital mortality between groups treated in rural, urban-teaching, and urban-non-teaching hospitals, as well as public and private hospitals. Mortality rates were also compared for variances between surgical treatment, sex, insurance, patient location, race, and income. Discharge data was collected for 256,240 inpatient stays from the 2012 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Results: Odds of mortality were 14.6% greater in rural hospital hip fracture patients compared to Urban/Non-Teaching centers (p < 0.05).

Conclusions: Results from this study lend support to necessitate further research investigating prospective barriers to care of those in rural settings. This may point to limitations in resources and trained medical and surgical specialists in rural hospitals and need for continued research to mitigate such findings.

Keywords: Hip fracture; Mortality; Rural; Social determinants; Teaching hospitals.