Óscar Lourenço

Causes of financial distress of Portuguese municipalities: empirical evidence

This paper analyses the factors behind the financial distress of local government in Portugal. A Probit model is used to estimate the probability of a municipality entering into a financial recovery contract, regulated by the Portuguese Local Finance Law. Empirical results indicate that both structural and non-structural factors influence local financial distress. In addition to financial management practices, financial distress is also conditioned by political variables and socio-economic factors. Municipalities ruled by mayors that belong to a right-wing party are more prone to financial distress, and some municipalities are more financially vulnerable than others because of structural circumstances.

AB0885 The Burden of Osteoporotic Hip Fractures in Portugal: Costs, Quality of Life and Mortality

Background Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tends to increase as life expectancy expands and life style changes favour osteoporosis (1). The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed (2). Objectives To estimate the overall societal cost of hip fractures, the per-patient costs and the impact on quality of life in Portugal, based on real-life individual patient data. Methods Information was collected on consumption of health resources, quality of life and mortality regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resources consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs. Multivariate analyses were carried out to assess the main determinants of Heath-related Quality of Life. Results Mean individual fracture-related costs were estimated at € 13,434 for the first year and € 5,985 for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at € 216. Mean reduction in quality of life 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed an excess of 12% in mortality in the 2 first year after hip fracture, when compared to the gender and age-matched general population. Conclusions Results of this study indicate that osteoporotic hip fractures are associated with a high societal burden, in terms of costs, loss in quality of life and mortality. These data provide valuable input to the design and selection of fracture prevention strategies. References Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of osteoporosis. 2013;8(1-2):136. Johnell O. The socioeconomic burden of fractures: today and in the 21st century. The American journal of medicine. 1997;103(2a):20S-5S; discussion 5S-6S. Disclosure of Interest None declared

THU0370 Hip Fractures in Portugal: 2006-2010 an Epidemiologic Analysis

Background Hip fractures are considered to be the most devastating consequence of osteoporosis. They require long hospitalizations and high health-care costs and represent an important cause of morbidity, disability, and mortality, especially in the elderly1. As patients are invariably hospitalized in most countries the epidemiology of hip fracture is well documented compared with other fracture outcomes and provides a surrogate for the total burden of osteoporosis2. Objectives To carry out an epidemiologic analyses of hip fractures incidence rates in Portugal. Methods All cases of hip fracture occurred at 40 years of age or above from 2006 to 2010 were extracted from the Portuguese National Hospital Discharge Register. Age and gender-stratified population data was collected from the Institute for National Statistics. Average annual incidences were computed for age and gender groups along with the associated mortality, length of hospital stay and destination of the patient after discharge. Statistical differences between genders were assessed trough IBM SPSS® 20 with 0.05 as level of significance. Results A total of 51701 hip fractures occurred in the period under analysis. Hip fracture incidence rates were higher in women than in men and increased with age. The lowest incidence was observed in the 40-44 age group (14.1 and 4.0 per 100,000 inhabitants for men and women, respectively). The highest rate was observed among the 95-100 age-group (2,577.6 and3,551.8/100,000 inhabitants, for men and women, respectively). The mean length of hospital stay was13.4 days for men and 14.2 days for women (t(19271.4)=6.731; p<0.05), respectively. We also found statistically significant differences between genders on patient’s destination after discharge (Chi Square(5)=253.099; p<0.05), the most frequent being: home 88.5% (men=85.3%; women=89.6%), mortality 5.1% (men=7.9%; women=4.3%), transferred for another hospital 3.9% (men=4.9%; women=3.7%), with homecare help 1.9% (men=1.2%; women=1.9%), discharge without medical consent 0.6%( men=0.7%; women=0.5%). Conclusions As expected women have a higher incidence of hip fractures. The Portuguese women are more likely to go home after being discharge of the hospital and have a lower mortality. Men are more likely to be transferred for another hospital. Further studies are necessary for access the mortality rates after discharge. References Kanis, J.A. & Johnell, O. (2005). Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int., 16:229–38. Cooper, C., Cole, Z.A., Holroyd, C.R., Earl, S.C., Harvey, N.C., Dennison, E.M., Melton, L.J., Cummings, S.R., & Kanis, J.A. (2011). Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int., 22:1277–88. Disclosure of Interest None Declared