National trends in cardiovascular mortality with hip fracture as a contributing cause among older adults in the United States, 1999–2019

Background

Hip fractures and cardiovascular disease (CVD) represent major, interrelated health burdens among older adults in the United States. This study characterizes national trends in CVD‐related mortality among individuals aged ≥ 65 years with hip fractures from 1999 through 2019.

Methods

We conducted a cross‐sectional analysis of CDC WONDER mortality data, identifying deaths with CVD (ICD-10: I00–I99) recorded as the underlying cause and hip-fracture codes (S72.0–S72.9) listed as contributing causes. Crude and age‐adjusted mortality rates (AAMRs) per 100,000 population were calculated annually and standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent changes (APCs) with 95 % confidence intervals (CIs). Trends were stratified by sex, race/ethnicity, metropolitan status, geographic region, and 10-year age groups.

Results

From 1999 to 2019, 214,992 CVD‐related deaths occurred in older adults with hip fractures. The overall AAMR declined from 29.99 in 1999 to 21.50 in 2013 (APC –2.72; 95 % CI, –3.97 to –2.43), followed by a nonsignificant decrease to 21.16 by 2019 (APC –0.52; 95 % CI, –1.27 to 0.81). Disparities in AAMR were seen among all variables with highest mortality rates observed among females, non-metropolitan areas and White individuals. Mortality increased markedly with age, up to 124.30 in those ≥ 85 years.

Conclusion

Although CVD-related mortality with hip fracture as a contributing cause has generally declined over two decades, substantial disparities persist by sex, race, geography, and age. Integrated, equity‐centered public health and clinical interventions targeting both cardiovascular and bone health are needed to further reduce preventable mortality in this vulnerable population.