J Korean Med Sci.  2023 May;38(18):e137. 10.3346/jkms.2023.38.e137.

Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort

• Jang SY
• Cha Y
• Kim Y
• Kim KJ
• Kim H
• Choy W

• KMID: 2542029
• DOI: http://doi.org/10.3346/jkms.2023.38.e137

Abstract

Background
The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented.
Methods
We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values.
Results
The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, −5%; 95% CI, −13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, −8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, −2%; 95% CI, −3 to −1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001).
Conclusions
In 2020, the incidence rate of hip fracture did not significantly decrease, and inhospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.

Keyword

Hip Fracture; COVID-19; Incidence; Mortality; Length of Hospital Stay

Figure

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  Fig. 1 These graphs show the results of interrupted time series analysis for annual IRs of hip fractures according to age (A) and sex (B, C).IR = incidence rate, APC = annual percentage change, PC = percentage change, CI = confidence interval.

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  Fig. 2 These graphs show the results of interrupted time series analysis for annual in-hospital mortality rates (A) and mean LOS in hip fractures (B).LOS = length of hospital stay, APC = annual percentage change, PC = percentage change, CI = confidence interval.

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  Fig. 3 These graphs show the results of interrupted time series analysis for annual proportions of surgery type in femoral neck fracture (A) and intertrochanter fracture (B).HA = hemiarthroplasty, IF = internal fixation, THA = total hip arthroplasty, PC = percentage change, CI = confidence interval.

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