Hip Fracture Hospitalizations in the U.S. by Urban-Rural Status: Nationwide Inpatient Sample, 2004

Purpose: Hip fracture is a leading cause of morbidity and mortality among older adults. While several risk factors for hip fracture have been identified, the role of rurality has not been examined. We compared hip fracture hospitalization rates and characteristics across four levels of rurality.

Methods: We performed a cross-sectional analysis of the 2004 Nationwide Inpatient Sample with hip fracture as the principal admitting diagnosis. Urban-rural status was based on patient's county of residence and categorized using Urban Influence Codes (large urban, small urban, large rural, small rural). Rates and 95% Confidence Intervals (95% CI) were calculated using U.S. Census population estimates.

Results: Higher rural rates persisted within all age brackets, for both genders. Females aged 85 years or older, living in large rural counties, had the largest hip fracture rate (2,519 per 100,000; 95%CI = 2,223-2,850). Of fractures with an e-code, falls accounted for 92% of hip fractures in women and 84% in men. Women's fall-related hip fracture rates increased with rurality (large urban, 105 per 100,000 persons (95%CI = 96-114); small urban, 117 (95%CI = 103-133); large rural, 150 (95%CI = 133-168); small rural, 154 (95%CI = 136-175). Men's fall-related hip fracture rates were highest in large urban counties and equal across the other levels of rurality.

Conclusions: Results suggest that rural residents have higher hip fracture rates compared with urban residents. This disparity is most apparent in rural, elderly women. These findings highlight the need for renewed interest in the prevention of falls, especially in rural women.