Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records

Prisco Piscitelli,^1,2 Giovanni Iolascon,³ Alberto Argentiero,² Giovanna Chitano,² Cosimo Neglia,² Gemma Marcucci,¹ Manuela Pulimeno,² Marco Benvenuto,² Santa Mundi,² Valentina Marzo,² Daniela Donato,⁴ Angelo Baggiani,⁴ Alberto Migliore,⁵ Mauro Granata,⁶ Francesca Gimigliano,³ Raffaele Di Blasio,⁷ Alessandra Gimigliano,³ Lorenzo Renzulli,⁷ Maria Luisa Brandi,¹ Alessandro Distante,^2,4 Raffaele Gimigliano<sup>3,7

1</sup>University of Florence, Florence Italy; ²ISBEM Research Centre, Brindisi, Italy; ³Second University of Naples, Naples, Italy; ⁴University of Pisa, Pisa, Italy; ⁵Fatebenefratelli St Peter’s Hospital, Rome, Italy; ⁶St Filippo Neri Hospital, Rome, Italy; ⁷Casa di Cura Santa Maria del Pozzo, Somma Vesuviana, Italy

Objectives: As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population.
Methods: We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820–821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433–434), and TIA (code 435) between 2001–2005. Cost analyses were based on diagnosis-related groups.
Results: The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005).
Conclusion: The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.

Keywords: hip fractures, strokes, acute myocardial infarction, incidence, hospital costs, rehabilitation costs