Allison J. Taylor

Health Care Expenditures Associated With Skeletal Fractures Among Medicare Beneficiaries, 1999–2005†‡

Fractures impose substantial burdens, in terms of both costs and health, on individuals and health care systems. This is particularly true for older Americans and the Medicare system. The objective of this study was to estimate the costs of care associated with selected fractures among Medicare beneficiaries. This was a retrospective, person‐level, pre/postfracture analysis using administrative data. The study used Medicare claims data from 1999 through 2005 for a 5% sample of Medicare beneficiaries. The subjects included Medicare beneficiaries, ≥65 yr of age, who had at least 13 mo of both Parts A and B coverage and not enrolled in Medicare Advantage and who experienced a closed fracture of the hip, femur, pelvis, tibia/fibula, ankle, distal forearm, nondistal radius/ulna, humerus, clavicle, spine, or wrist, or any fracture of the distal forearm or ankle during the years 2000 through 2005. The main outcome measures were incremental (greater than baseline) and attributable (directly associated) payments for Medicare‐covered services for the first 6 mo after incident fractures. Incremental payments ranged from

Clinical and demographic factors associated with fractures among older Americans

7788 (95% CI,

Fatal occupational electrocutions in the United States.

7550–

Pathologic fractures: should these be included in epidemiologic studies of osteoporotic fractures?

8025) for distal forearm fractures to

The delivery of evidence-based preventive care for older Americans with arthritis

31,310 (95% CI,

The April 8, 1998 tornado: assessment of the trauma system response and the resulting injuries

31,073–

Hypothermia deaths in Jefferson County, Alabama.

31,547) for open hip fractures; the attributable payments for distal forearm and hip fractures were

Death during theft from electric utilities.

1856 and

Seatbelt Use During Pregnancy: A Comparison of Women in Two Prenatal Care Settings

18,734, respectively. Fractures are associated with substantial increases in health services utilization and costs among Medicare beneficiaries, but significant proportions of those costs are not directly attributable to fracture treatment. Further research is needed to ascertain other health conditions that are driving costs for Medicare beneficiaries after fractures.

Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death.

SummaryMedicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.IntroductionThis study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies.MethodsWe used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005.ResultsFor each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture.ConclusionsThis study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.