Mortality and Risk Factors After Hip Fracture in Patients Aged 50 Years and Older: A Minimum 10-Year Follow-up Using Jeju Island Cohort Study.

BACKGROUND: Hip fractures are associated with a high mortality rate; however, long-term follow-up studies are limited. This study aimed to evaluate mortality and its associated risk factors in patients with hip fractures over a minimum follow-up period of 10 years within a prospective cohort. METHODS: Data were obtained from a cohort of hip fractures on Jeju Island (2002-2011). Mortality was assessed in patients with at least 10 years of follow-up. Among 1,952 eligible patients, survival outcome was confirmed for 1,840 patients with 112 lost to follow-up. Mortality rates were estimated using Kaplan-Meier analysis. Risk factors were examined with log-rank tests and Cox proportional hazards regression, including sex, age, fracture type, subsequent fracture, surgical intervention and comorbidity. RESULTS: Among 1,840 patients, 1,545 deaths and 295 survivors were identified. Cumulative mortality was 17.1% at 1 year, 32.9% at 3 years, 46.7% at 5 years, and 71.4% at 10 years. Kaplan-Meier analysis showed significant differences by age (P < 0.001), type of fracture (P < 0.001), surgical treatment (P = 0.004), and comorbidity (P < 0.001). Multivariate Cox regression identified age, sex, surgery and comorbidity as independent predictors: advanced age, male sex, non-operative management and high comorbidity burden were significantly associated with increased mortality. CONCLUSION: Hip fracture patients exhibit steadily increasing mortality, exceeding 70% at 10 years. Advanced age, male sex, lack of surgical treatment and high comorbidity burden are independent risk factors. Strategies targeted at these high-risk groups are essential to improve long-term survival.