Underreporting of mortality related to fractures as compared to dementia in 641 women 75-105 years followed for 22 years in a population-based primary care study in Sweden.

Katarina Walseth Krøgenes, Hans Thulesius, Brita Zilg, Robert Eggertsen, Anna Segernäs, Pär Wanby, Ulrica Molstad, Lisa Alvunger, Ferdinando Petrazzuoli, Daniel Albertsson

Keywords: Fragility fractures. Dementia. Cause of death certificate.

Background:

Fragility fractures and dementia seem to have bidirectional associations. Overall, one-year mortality reaches 20-30% for hip fractures and similar figures are reported for dementia. Since accuracy of mortality statistics decreases with age, we aimed to investigate causes of death in a primary care cohort of 75-105 year old women in rural Sweden.

Research questions:

To what degree were fragility fractures and dementia mentioned in cause of death certificates? What percentage of death certificates were issued by primary care physicians? What was the autopsy rate?

Method:

Death certificates and hip, pelvis, humerus and vertebral fracture data 2002-2024 from patient records were categorized according to ICD in a population-based sample of 641 women born 1901-1931.

Results:

Mean death age was 90 years. Fragility fractures were found in patient records for 75 of 641 women (12%) within 1 year before death. Median time from fracture to death was 70 days (range 1-362 days). Fracture was noted in death certificates of 16 women (2.5%); as terminal or underlying cause of death in 4 cases, and as contributing cause of death in 12 cases. Of the 16 women, 3 died 1 day after their fracture - mentioned as contributing cause of death. For 59 women (9.2%), fracture was not mentioned in their death certificates. Dementia was noted in the death certificates of 114 of 641 women (18%); as terminal or underlying cause of death in 41 women, and as contributing cause of death in 73 women. Primary care physicians issued 75% of the death certificates. Autopsy rate was 1.4%.

Conclusions:

Cause of death according to death certificates included dementia in 18% and fragility fractures in 2.5%. We noted a seemingly higher fracture mortality clinically indicating an underreporting of fracture mortality as compared to dementia mortality. Most death certificates were issued by primary care physicians. Autopsy rate was low.

Points for discussion:

Are death certificates for people of high age issued by primary care physicians in your jurisdiction/country?

Are autopsies often performed for people of high age in your jurisdiction/country?

Were you surprised by the results of this study?

#113