eAppendix 1 eTable 1
We used the following diagnosis codes to identify hip fractures: ICD-8 820XX and ICD-10 S72.0, S72.1, and S72.2.
Disease categories and the International Classification of Diseases codes, the Eighth Revision (ICD-8) and the Tenth Revision (ICD-10) used to calculate the Charlson Comorbidity Index.
Disease category ICD-8 ICD-10 Score
Myocardial infarction 410 I21-I23 1
Congestive heart failure 427.09; 427.10; 427.11;
427.19; 428.99; 782.49
I50; I11.0; I13.0; I13.2
1 Peripheral vascular disease 440; 441; 442; 443; 444; 445 I70- I74; I77 1
Cerebrovascular disease 430-438 I60-I69; G45; G46 1
Dementia 290.09-290.19; 293.09 F00-F03; F05.1; G30 1
Chronic pulmonary disease 490-493; 515-518 J40-J47; J60-J67; J68.4;
J70.1; J70.3; J84.1; J92.0;
J96.1; J98.2-J98.3
1 Connective tissue disease 712; 716; 734; 446; 135.99 M05; M06; M08; M09; M30-
M36; D86 1
Ulcer disease 530.91; 530.98; 531-534 K22.1; K25-K28 1
Mild liver disease 571; 573.01; 573.04 B18; K70.0-K70.3; K70.9;
K71; K73; K74; K76.0 1
Diabetes 249.00; 249.06; 249.07;
249.09; 250.00; 250.06;
250.07; 250.09
E10.0; E10.1; E10.9; E11.0;
E11.1; E11.9 1
Hemiplegia 344 G81; G82 2
Moderate to severe renal disease
403; 404; 580-584; 590.09;
593.19; 753.10-753.19; 792
I12; I13; N00-N05; N07;
N11; N14; N17-N19; Q61 2 Diabetes with end organ
damage
249.01-249.05; 249.08;
250.01-250.05; 250.08
E10.2-E10.8;
E11.2-E11.8 2
Any tumor 140-194 C00-C75 2
Leukemia 204-207 C91-C95 2
Lymphoma 200-203; 275.59 C81-C85; C88; C90; C96 2
Moderate to severe liver disease
070.00; 070.02; 070:04;
070.06; 070.08; 573.00;
456.00-456.09
B15.0; B16.0; B16.2; B19.0;
K70.4; K72; K76.6; I85 3
Metastatic solid tumor 195-199 C76-C80 6
AIDS 079.83 B21-B24 6
eAppendix 2
eTable 1. Mortality after hip fracture in Denmark 1980-2014, by sex, age, and Charlson Comorbidity Index score.
0-30 day mortality 31-365 day mortality
No. of deaths
Mortality risk
Mortality rate ratio (95% CI) No. of deaths
Mortality risk
Mortality rate ratio (95% CI)
Crude Adjusted* Crude Adjusted*
Sex
Male 11093 15.26 (15.00–15.52) Reference Reference 15308 25.16 (24.82–25.51) Reference Reference
Female 15999 8.44 (8.32–8.57) 0.53 (0.52–0.55) 0.48 (0.47–0.49) 31960 18.60 (18.42–18.79) 0.71 (0.70–0.72) 0.65 (0.64–0.66) Age (years)
55-64 732 3.46 (3.22–3.72) Reference Reference 2011 9.98 (9.57–10.40) Reference Reference
65-74 2813 5.64 (5.44–5.85) 1.65 (1.52–1.79) 1.67 (1.54–1.81) 6140 13.21 (12.91–13.52) 1.35 (1.28–1.42) 1.33 (1.26–1.40) 75-84 9426 9.07 (8.90–9.25) 2.70 (2.50–2.91) 2.87 (2.66–3.09) 17866 19.08 (18.83–19.33) 2.01 (1.92–2.11) 2.05 (1.95–2.14) 85+ 14121 16.18 (15.93–16.42) 5.02 (4.66–5.40) 5.84 (5.42–6.29) 21251 29.38 (29.05–29.71) 3.33 (3.18–3.49) 3.63 (3.47–3.80) Charlson Comorbidity Index (CCI) score
Normal (score 0) 8933 7.29 (7.14–7.43) Reference Reference 16085 14.25 (14.05–14.46) Reference Reference Moderate (score1) 6278 10.77 (10.52–11.03) 1.53 (1.48–1.58) 1.47 (1.42–1.52) 10828 21.04 (20.69–21.40) 1.57 (1.53–1.61) 1.52 (1.48–1.56) Severe (score 2) 5166 12.54 (12.22–12.86) 1.82 (1.75–1.88) 1.74 (1.68–1.80) 9347 26.27 (25.82–26.74) 2.05 (2.00–2.10) 1.99 (1.94–2.04) Very severe (score ≥3) 6715 16.74 (16.37–17.10) 2.53 (2.45–2.62) 2.48 (2.39–2.56) 11008 33.63 (33.12–34.15) 2.83 (2.76–2.90) 2.81 (2.74–2.88)
* Adjusted for age, sex, and comorbidity (Charlson Comorbidity Index score) when appropriate.
eTable 2. Mortality after hip fracture in Denmark from 1980 through 2014, by sex and age
Standardized mortality rates by calendar periods of diagnosis
1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014
0-30 day
Sex Female 119.51 (113.74–125.28) 127.25 (121.99–132.50) 116.17 (111.52–120.81) 107.73 (103.41–112.06) 110.83 (106.46–115.21) 110.38 (105.88–114.88) 112.13 (107.35–116.91)
Male 239.07 (224.80–253.35) 221.64 (209.71–233.57) 214.28 (203.72–224.84) 219.72 (209.39–230.05) 223.81 (213.50–234.12) 210.50 (200.54–220.45) 200.49 (190.70–210.28)
Age, years 55-64 42.85 (33.73–51.97) 53.50 (43.47–63.53) 47.22 (37.96–56.48) 41.84 (32.93–50.75) 48.45 (39.47–57.43) 46.52 (38.50–54.54) 34.62 (27.54–41.69) 65-74 65.47 (58.59–72.36) 72.86 (66.02–79.70) 72.62 (65.84–79.40) 82.19 (74.91–89.47) 76.02 (68.59–83.46) 73.17 (65.76–80.58) 56.46 (50.17–62.76) 75-84 122.15 (114.90–129.41) 123.71 (117.20–130.23) 118.46 (112.52–124.40) 120.52 (114.51-126.53) 120.98 (114.88–127.08) 112.28 (106.10–118.45) 107.56 (101.04–114.09) 85+ 241.75 (228.96–254.53) 238.96 (227.88–250.04) 219.54 (209.93–229.16) 201.74 (192.98–210.50) 215.41 (206.52–224.30) 218.52 (209.55–227.49) 229.72 (220.39–239.06)
31-365 days
Sex Female 26.46 ( 25.55–27.37) 25.35 (24.56–26.15) 25.76 (25.03–26.48) 25.18 (24.49–25.88) 24.83 (24.14–25.52) 24.65 (23.95–25.36) 23.62 (22.85–24.38)
Male 40.57 (38.40–42.73) 38.76 (36.97–40.55) 37.42 (35.85–38.98) 36.93 (35.44–38.43) 38.01 (36.51–39.51) 34.17 (32.78–35.57) 32.50 (31.05–33.94) Age, years 55-64
8.51 (7.30–9.71) 11.08 (9.69–12.48) 12.70 (11.21–14.19) 12.98 (11.46–14.50) 13.78 (12.29–15.28) 12.47 (11.18–13.76) 10.84 (9.55–12.12) 65-74
15.57 (14.51–16.63) 14.80 (13.82–15.77) 16.24 (15.23–17.26) 17.68 (16.61–18.76) 17.47 (16.33–18.61) 14.94 (13.88–16.00) 14.05 (13.01–15.09) 75-84
25.71 (24.61–26.81) 24.20 (23.24–25.15) 24.71 (23.82–25.60) 24.80 (23.91–25.70) 24.76 (23.85–25.66) 23.39 (22.47–24.32) 22.23 (21.21–23.25) 85+ 44.77 (42.80–46.74) 43.12 (41.46–44.79) 41.83 (40.36–43.30) 39.55 (38.21–40.90) 40.17 (38.83–41.51) 40.29 (38.95–41.64) 38.76 (37.35–40.16)
eTable 3. Mortality after hip fracture in Denmark from 1980 through 2014, by Charlson Comorbidity Index score.
CCI, Normal CCI, Moderate CCI, Severe CCI, Very severe
Calendar period of diagnosis
Standardized mortality rates*
Adjusted mortality rate ratio (95% CI)**
Standardized mortality rates
Adjusted mortality rate ratio (95% CI)*
Standardized mortality rates
Adjusted mortality rate ratio (95% CI)*
Standardized mortality rates
Adjusted mortality rate ratio (95% CI)*
0-30 day
1980-1984 125.31 (118.94–131.68) Reference 186.56 (171.53–
201.59) Reference 195.55 (174.50–
216.60) Reference 271.54 (237.61–305.48)
Reference
1985-1989 121.11 (115.20-
127.03) 0.97 (0.90–1.04) 175.34 (163.63-
187.04) 0.92 (0.83–1.02) 200.1 (183.7-216.5) 1.03 (0.91–1.17) 249.5 (227.0–271.0) 0.93 (0.81–1.08) 1990-1994 102.79 (97.60–
107.99) 0.82 (0.76–0.88) 165.14 (154.87-
175.41) 0.85 (0.77–0.94) 188.63 (174.98–
202.27) 0.95 (0.84–1.08) 250.55 (231.97–269.12) 0.94 (0.82–1.07) 1995-1999 96.88 (91.76–102.00) 0.78 (0.72–0.84) 146.5 (137.3-155.7) 0.76 (0.69–0.84) 169.71 (158.03–
181.38) 0.87 (0.77–0.98) 236.41 (221.14–251.67) 0.87 (0.76–0.99) 2000-2004 90.73 (85.43–96.03) 0.72 (0.67–0.78) 142.50 (133.62-
151.39) 0.73 (0.66–0.81) 173.13 (161.89–
184.37) 0.88 (0.78–0.99) 232.88 (219.83–245.93) 0.85 (0.75–0.97) 2005-2009 83.09 (77.56–88.62) 0.66 (0.61–0.72) 133.37 (124.57-
142.17) 0.68 (0.62–0.76) 153.53 (142.95–
164.11) 0.77 (0.68–0.87) 221.18 (209.69–232.67) 0.82 (0.72–0.93) 2010-2014 80.92 (74.91–86.93) 0.64 (0.58–0.70) 124.37 (115.40-
133.35) 0.64 (0.58–0.71) 147.96 (137.40–
158.51) 0.75 (0.66–0.85) 209.26 (198.60–219.92) 0.78 (0.69–0.88) 31-365 days
1980-1984 24.72 (23.74–25.70) Reference 34.00 (31.76–36.25) Reference 50.32 (46.39–54.24) Reference 63.29 (57.33–69.24) Reference
1985-1989 21.69 (20.84–22.55) 0.88 (0.83–0.92) 33.19 (31.40–34.99) 0.94 (0.87–1.02) 42.52 (39.86–45.19) 0.84 (0.77–0.92) 59.61 (55.54–63.68) 0.92 (0.83–1.02)
1990-1994 20.62 (19.84–21.40) 0.84 (0.79–0.88) 31.66 (30.13–33.19) 0.93 (0.86–1.00) 42.41 (40.14–44.69) 0.83 (0.76–0.90) 57.60 (54.34–60.85) 0.90 (0.82–1.00)
1995-1999 19.35 (18.59–20.11) 0.79 (0.75–0.83) 30.66 (29.22–32.10) 0.88 (0.82–0.95) 39.70 (37.73–41.67) 0.79 (0.72–0.85) 49.80 (47.30–52.29) 0.78 (0.71–0.86)
* Standardized to the age and sex distribution of hip fracture patients in the year 2000; **Adjusted for age and sex.
2000-2004 18.98 (18.17–19.78) 0.77 (0.73–0.81) 28.38 (27.03–29.72) 0.82 (0.76–0.88) 34.54 (32.80–36.28) 0.68 (0.63–0.74) 49.27 (47.13–51.41) 0.78 (0.71–0.85)
2005-2009 17.69 (16.85–18.54) 0.71 (0.67–0.76) 26.78 (25.45–28.12) 0.77 (0.71–0.83) 31.19 (29.57–32.81) 0.62 (0.57–0.68) 43.64 (41.84–45.45) 0.69 (0.63–0.76)
2010-2014 15.73 (14.82–16.64) 0.62 (0.58–0.66) 24.26 (22.86–25.65) 0.68 (0.63–0.74) 28.60 (26.94–30.27) 0.56 (0.51–0.61) 42.47 (40.68–44.27) 0.66 (0.60–0.72)
eTable 4. 30-day and 31-365 day mortality rate ratios associated with individual comorbidities after first-time hospitalization for hip fracture surgery, Denmark, 1980-2014.
.
* Adjusted for the other comorbidities, age, and sex
Adjusted mortality rate ratio (95% CI)*
0-30 days 31-365 days
No comorbid diseases Reference Reference
Myocardial infarction 1.21 (1.16–1.26) 1.13 (1.09–1.17)
Congestive heart failure 1.62 (1.56–1.68) 1.41 (1.37–1.45) Peripheral vascular disease 1.16 (1.11–1.22) 1.23 (1.18–1.27) Cerebrovascular disease 1.07 (1.04–1.10) 1.10 (1.08–1.13)
Dementia 1.48 (1.43–1.54) 1.70 (1.65–1.75)
Chronic pulmonary disease 1.49 (1.44–1.54) 1.46 (1.42–1.50) Connective tissue disease 0.93 (0.88–0.99) 1.03 (0.99–1.08)
Peptic ulcer disease 1.07 (1.03–1.12) 1.11 (1.07–1.15)
Mild liver disease 1.53 (1.37–1.70) 1.53 (1.42–1.66)
Diabetes I and II 1.19 (1.13–1.25) 1.17 (1.13–1.22)
Hemiplegia 0.98 (0.82–1.18) 1.01 (0.89–1.16)
Moderate / severe renal disease 1.42 (1.33–1.51) 1.30 (1.24–1.37) Diabetes with end-organ damage 1.02 (0.94–1.10) 1.05 (0.99–1.11)
Non-melanoma tumor 1.19 (1.15–1.23) 1.50 (1.47–1.54)
Leukemia 1.62 (1.39–1.88) 1.52 (1.34–1.73)
Lymphoma 1.42 (1.26–1.61) 1.71 (1.57–1.87)
Moderate to severe liver disease 1.59 (1.32–1.91) 1.60 (1.39–1.85)
Metastatic solid tumor 2.22 (2.06–2.39) 3.01 (2.86–3.17)
eTable 5. Sensitivity analyses in which we included both diagnosis and surgery codes available for the period 1996-2014 to identify the study population.
Year
Number of hip fracture surgery based diagnosis codes*
Number of hip fracture surgery based surgery codes**
1996 8384 8944
1997 8138 8435
1998 8028 8236
1999 8181 8284
2000 8109 8256
2001 8190 8188
2002 8037 8042
2003 7831 7796
2004 7918 7918
2005 7938 7924
2006 7722 7669
2007 7659 7626
2008 7774 7659
2009 7335 7234
2010 7625 7458
2011 7356 7105
2012 7061 6808
2013 7049 6796
2014 7060 6759
