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The American Journal of Managed Care September 2017
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Racial and Ethnic Differences in Hip Fracture Outcomes in Men
Lucy H. Liu, MD, MPH; Malini Chandra, MS, MBA; Joel R. Gonzalez, MPH, MPP; and Joan C. Lo, MD
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Racial and Ethnic Differences in Hip Fracture Outcomes in Men

Lucy H. Liu, MD, MPH; Malini Chandra, MS, MBA; Joel R. Gonzalez, MPH, MPP; and Joan C. Lo, MD
Racial and ethnic differences in hip fracture incidence and mortality outcome were observed within a diverse population of older men, with lower rates of both among Asians.
Although men contribute a much smaller subset of the hip fracture population than women, they suffer greater morbidity and mortality compared with women. In our study, 1-year mortality following hip fracture was 32.9% in men—substantially higher than women (22.8%) within the same healthcare setting.23 National and regional data also demonstrate higher mortality rates up to 1 year post hip fracture in men compared with women.2,34 Because men may be less prone to falls, those who do experience hip fracture may have increased frailty, greater comorbidity, higher susceptibility to medical complications (eg, pneumonia), and potentially lower rates of subsequent bisphosphonate therapy compared with women.18,32,43 Whether the observed gender differences in mortality risk following hip fracture relate to pre- or postfracture health, including a potentially greater contribution of infection-related complications in men,15 is unclear.

Our study contributes to the growing recognition of racial/ethnic differences in postfracture mortality. Similar to women, 1-year mortality rates following hip fracture were lower in Asian men, but mortality rates were comparable for white, black, and Hispanic men. A recent study examining nonfederal hospital admissions for hip fracture–related procedures in California reported more than one-third lower postfracture mortality risk for Asian men and somewhat lower mortality risk among black and Hispanic compared with white men.34 Whether hospital readmission or other postfracture complications,44 as well as ethnic differences in family structure, social support, and use of rehabilitation services,45-48 contribute to these findings is unclear. Contemporary data pertaining to US Asian men also remain limited. Collectively, these findings emphasize the need to further investigate factors underlying the observed ethnic differences in hip fracture outcomes among older men.

Limitations and Strengths

Our study has several limitations. First, we did not examine specific preexisting comorbidities, functional status, osteoporosis risk factors, and treatment, which may differ by race and play an important role in patient outcomes. Second, information on mobility and/or functional independence, discharge to inpatient rehabilitation, body mass index, and nutritional status were not systematically available. Lastly, we were unable to account for population trends in mortality to determine whether the observed racial differences reflect mortality patterns within our health plan population, irrespective of hip fracture. 

The strengths of our study include access to an extremely large and diverse population, with comprehensive data on mortality outcomes and hospitalized events. Asians represent one of the fastest growing ethnic subgroups within the United States, among whom a better understanding of hip fracture epidemiology and outcome has become increasingly important. These data are among the first to examine contemporary differences in both hip fracture rates and mortality outcome in men of Asian ethnicity and white race receiving care within the same healthcare delivery system.


We noted important racial/ethnic differences in hip fracture incidence and 1-year mortality outcome following the fracture. Compared with men of white race, Asian men had two-thirds lower hip fracture incidence and one-third lower mortality risk at 1 year following hip fracture. As the aging population becomes increasingly diverse, a greater understanding of the cultural, social, and health-related factors affecting fracture outcomes in healthcare settings will optimize the targeting of multidisciplinary efforts to reduce morbidity and mortality following hip fracture in men.

Author Affiliations: Department of Medicine, Kaiser Permanente Oakland Medical Center (LHL, JCL), Oakland, CA; Division of Research, Kaiser Permanente Northern California (MC, JRG, JCL), Oakland, CA.

Source of Funding: None.

Author Disclosures: Ms Chandra has previously received research funding from Amgen. Dr Lo has previously received research funding from Amgen and Sanofi. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (LHL, MC, JCL); acquisition of data (MC, JCL); analysis and interpretation of data (LHL, MC, JRG, JCL); drafting of the manuscript (LHL, JCL); critical revision of the manuscript for important intellectual content (LHL, MC, JRG, JCL); statistical analysis (MC); provision of patients or study materials (JCL); administrative, technical, or logistic support (LHL, JRG, JCL); and supervision (JCL). 

Address Correspondence to: Joan C. Lo, MD, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. E-mail: 

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