Association between pre-hip fracture depression and days at home after fracture and assessing sex differences

Mehta, Rhea, Denise L. Orwig, Chixiang Chen, Yu Dong, Michelle D. Shardell, Takashi Yamashita, and Jason R. Falvey. “Association between Pre-Hip Fracture Depression and Days at Home after Fracture and Assessing Sex Differences.” Journal of the American Geriatrics Society. July 30, 2024. https://doi.org/10.1111/jgs.19096.

Rights

This is the peer reviewed version of the following article: Mehta, Rhea, Denise L. Orwig, Chixiang Chen, Yu Dong, Michelle D. Shardell, Takashi Yamashita, and Jason R. Falvey. “Association between Pre-Hip Fracture Depression and Days at Home after Fracture and Assessing Sex Differences.” Journal of the American Geriatrics Society. July 30, 2024. https://doi.org/10.1111/jgs.19096., which has been published in final form at https://doi.org/10.1111/jgs.19096. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

Subjects

sex difference
hip fracture
depression
Medicare

Abstract

Background Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear. Methods Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models. Results Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; p < 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; p < 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; p = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; p = 0.66). There was no evidence of effect modification by sex. Conclusions The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.