J Korean Hip Soc.  2010 Dec;22(4):305-311. 10.5371/jkhs.2010.22.4.305.

Identification and Validation of Osteoporotic Hip Fracture Using the National Health Insurance Database

• Park C
• Jang S
• Jang S
• Ha YC
• Lee YK
• Yoon HK
• Shin CS
• Kim DY
• Lee SS
• Choi HJ
• Kim BT
• Choi JY

• KMID: 1461186
• DOI: http://doi.org/10.5371/jkhs.2010.22.4.305

Abstract

PURPOSE
The aim of this study was to develop and validate identification criteria for the cases of osteoporotic hip fracture using the National Health Insurance Database, and we calculated the incidence rate of osteoporotic hip fracture in the Korean population using these criteria.
MATERIALS AND METHODS
The criteria to identify osteoporotic hip fracture using a diagnosis code, a procedure code, the type and number of medical service usages and the patients' ages were developed via discussions among experts. These criteria were validated by using a hip fracture cohort in which all the genuine osteoporotic hip fracture patients in the Jeju area were identified by reviewing the registered medical records and radiographs. By applying the identification criteria to the National Health Insurance Database that was accumulated until June 2009, we calculated the incidence rate of osteoporotic hip fracture in patients between 50 and 100 years of age in 2008.
RESULTS
The identification criteria had a sensitivity of 93.1% and a positive predictive value of 77.4%. A total of 20,432 osteoporotic hip fracture cases were identified in 2008, and the incidence rate was 15.7 cases per 10,000 persons. The osteoporotic hip fracture incidence rate for females was 20.7 (per 10,000persons), and this was 2.1 times higher than that for the males (9.8case per 10,000persons), and the rates were increased with age.
CONCLUSION
The incidence of osteoporotic hip fracture that occurred on a nationwide scale can be more precisely estimated by using the National Health Insurance Database with its comprehensive information on the overall details of treatment as well as the diagnosis codes, and so the incidence of osteoporotic hip fracture can be reliably calculated for each year. The results from this research could be used as evidence in a hip fracture management plan for establishing Korean Health policy.

Keyword

Osteoporotic hip fracture; Incidence rate; National Health Insurance Database

MeSH Terms

Cohort Studies
Female
Health Policy
Hip
Humans
Incidence
Male
Medical Records
National Health Programs

Figure

• 

  Fig. 1 Age-specific Incidence of Osteoporotic Hip Fracture in Both Genders

Reference

1. Compston J. Invest in your bones. International Osteoporosis Foundation [Internet]. 2008. Available from : http://www.iofbonehealth.org/download/osteofound/filemanager/publications/pdf/stand-tall-thematic-report-08-english.pdf.

2. Kang HY, Yang KH, Kim YN, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health. 2010. 10:230.

3. Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009. 91:2376–2380.

4. Kim SR, Ha YC, Kim JR, Kim R, Kim SY, Koo KH. Incidence of hip fractures in jeju island, South Korea: a prospective study (2002-2006). Clin Orthop Surg. 2010. 2:64–68.

5. Lim S, Koo BK, Lee EJ, et al. Incidence of hip fractures in Korea. J Bone Miner Metab. 2008. 26:400–405.

6. Shin CS, Jo NH, Kim Y, et al. Study of an osteoporosis management program in Korea. 2007. Seoul National University;Unpublished manuscript.

7. Rowe SM, Yoon TR, Ryang DH. An epidemiological study of hip fracture in Honam, Korea. Int Orthop. 1993. 17:139–143.

8. Rowe SM, Song EK, Kim JS, et al. Rising incidence of hip fracture in Gwangju City and Chonnam Province, Korea. J Korean Med Sci. 2005. 20:655–658.

9. Korean National Health and Nutrition Examinatin Survey in 2008 results presentation. Korea Centers for Disease Control and Prevention. Cited 2009 Dec 29. Available from : http://knhanes.cdc.go.kr.

10. National Heath Insurance Statstics : The first half of 2008. National Health Insurance Corporation. Cited 2009 Mar 2. Available from : http://www.nhic.or.kr.

11. Kim JY, Kim HY, Im JH. Development of risk adjustment and prediction methods for care episodes using National Health Insurance Database. 2007. Seoul: Health Insurance Review & Assessment Service.

12. Ko MJ, Han JT, Lee AK, Kim MK, Park SH. Health checkup examinees cohort establishment : The development of assessment [monograph on the internet]. 2008. cited 2010 Dec 17. Seoul: National Health Insurance Corporation;Available from: http://www.nhic.or.kr/cms/board/board/Board.jsp?act=VIEW&communityKey=B0069&boardId=154.

13. Park BJ, Sung JH, Park KD, Seo SW, Kim SW. Improving the validity of health insurance Disease code and the utilization of health insurance claim data. 2003. Seoul: Seoul National University College of Medicine;19–30.

14. Westfall G, Littlefield R, Heaton A, Martin S. Methodology for identifying patients at high risk for osteoporotic fracture. Clin Ther. 2001. 23:1570–1588.

15. Ray WA, Griffin MR, Fought RL, Adams ML. Identification of fractures from computerized Medicare files. J Clin Epidemiol. 1992. 45:703–714.

16. Lippuner K, Golder M, Greiner R. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int. 2005. 16:Suppl 2. S8–S17.

17. Feldstein AC, Nichols GA, Elmer PJ, Smith DH, Aickin M, Herson M. Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Joint Surg Am. 2003. 85:2294–2302.

18. Korean Statistical Informatin Service. Cited 2009 Sep 10. Available from : http://kosis.kr/.

19. Chen HF, Ho CA, Li CY. Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study. Diabetes Care. 2008. 31:75–80.

20. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009. 302:1573–1579.

21. Nieves JW, Bilezikian JP, Lane JM, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010. 21:399–408.

22. Shin HH, Kim SY, Sohn SJ. Estimation of incidence rate of osteoporotic fracture among the elderly in a city. Korean J Bone Metab. 2001. 8:159–172.

23. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001. 12:417–427.

24. Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res. 2009. 24:1299–1307.