The Association between Glaucoma Severity and Hip Fractures in California Medicare Beneficiaries

Abstract

Purpose

To examine the association between glaucoma severity and hip fractures in older adults.

Design

Retrospective cross-sectional study.

Subjects

California (CA) Medicare beneficiaries in 2019 with Parts A & B coverage.

Methods

Multivariable logistic regression was used to analyze the association between glaucoma severity (mild, moderate, and severe vs. no glaucoma) and hip fracture, after adjusting for age, sex, race and ethnicity, and Charlson Comorbidity Index score. A subgroup analysis was performed only in individuals with glaucoma to examine the odds of hip fracture for those with moderate and severe glaucoma compared to those with mild glaucoma.

Main Outcome Measures

The variations in the odds of hip fractures for patients with and without glaucoma and for patients with moderate and severe glaucoma compared to those with mild glaucoma.

Results

Of the 2 717 346 beneficiaries in the study population, 220 662 (8.1%) had glaucoma. In multivariable regression analysis, those with mild (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.78–0.88) and moderate glaucoma (OR: 0.88; 95% CI: 0.84–0.92) had reduced odds of hip fracture compared with those with no glaucoma. There was no statistically significant association between severe vs. no glaucoma and hip fracture (OR: 0.96; 95% CI: 0.91–1.02). Among individuals with glaucoma, the odds of hip fracture were higher for those with severe glaucoma (OR: 1.17; 95% CI: 1.08–1.27), compared with those with mild glaucoma.

Conclusions

In the CA Medicare population, the presence of glaucoma was associated with decreased likelihood of hip fracture. However, in those with glaucoma, increased glaucoma severity was associated with an increased likelihood of hip fracture. Potential mediating mechanisms requiring further study include fear of falls and physical inactivity in patients with glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.