J Bone Metab 2015;22:17-21 http://dx.doi.org/10.11005/jbm.2015.22.1.17 pISSN 2287-6375 eISSN 2287-7029 Original Article Incidence and Mortality after Proximal Humerus Fractures Over 50 Years of Age in South Korea: National Claim Data from 2008 to 2012 Chanmi Park1, Sunmee Jang2, Areum Lee2, Ha Young Kim3, Yong Beom Lee4, Tae Young Kim4, Yong Chan Ha5 1Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul; 2College of Pharmacy, Gachon University, Incheon; 3Division of Endocrinology and Metabolism, University of Wonkwang College Medicine, Sanbon Medical Center, Gunpo; 4Department of Orthopaedic Surgery, School of Medicine, Hallym University, Anyang; 5Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea Corresponding author Background: There has been lack of epidemiology of proximal humerus fracture using Tae Young Kim nationwide database in Asia. The purpose of this study was to investigate the incidence Hallym University Sacred Heart Hospital, of proximal humerus fracture and its mortality following proximal humerus fracture in Department of Orthopaedic Surgery, 22 Korean over 50 years of age. Methods: The Korean National Health Insurance data were Gwanpyeong-ro 170beon-gil, Dongan-gu, evaluated to determine the incidence and mortality of proximal humerus fracture aged Anyang 431-070, Korea 50 years or older from 2008 through 2012. Results: Proximal humerus fracture increased Tel: +82-31-380-3770 by 40.5% over 5 year of study. The incidence of fracture increased from 104.7/100,000 in Fax: +82-31-382-1814 2008 to 124.7/100,000 in 2012 in women and from 45.3/100,000 in 2008 to 52.0/100,000 E-mail: [email protected] in 2012 in men, respectively. One year mortality rate after proximal humerus fracture was 8.0% in 2008 and 7.0% in 2012. One year mortality rate were 10.8% for men and Received: February 6, 2015 7.0% for women in 2008 and 8.5% for men and 6.4% for women in 2012. Conclusions: Revised: February 26, 2015 Our study showed that the proximal humerus fracture in elderly was recently increasing Accepted: February 27, 2015 and associated with high mortality in Korea. Considering proximal humerus fracture was associated with an increased risk of associated fractures and an increased mortality risk, No potential conflict of interest relevant to this public health strategy to prevent the proximal humerus fracture in elderly will be man- article was reported. datory. The national claim data of this research was Key Words: Humeral fractures, Incidence, Mortality, Osteoporotic fractures provided by the National Health Insurance Service (NHIS). This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Korea (grant number : HI13C1522). INTRODUCTION The number of osteoporosis and osteoporotic fracture has increased with life Copyright © 2015 The Korean Society for Bone and Mineral Research expectancy which is a major public health problem. Proximal humerus fractures This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Li- are the third most frequent fractures in the elderly and reported that they were cense (http://creativecommons.org/licenses/by-nc/3.0/) associated with the poor outcome such as persistent pain and limited activities.[1] which permits unrestricted non-commercial use, distribu- tion, and reproduction in any medium, provided the original Several studies reported that the patients with proximal humerus fracture tend to work is properly cited. have additional fractures at the fragile bone which can lead to the excessive mor- tality.[2,3] However, previous studies for the epidemiology of proximal humerus fractures have had limitation that may influence their results of the studies, in- http://e-jbm.org/ 17 Chanmi Park, et al. cluding small sample size, the inclusion for all ages of hu- Unique personal identifier permitted the tracking of indi- merus fracture and the enrollment from specific areas resi- viduals for multiple visit or admissions. Where an individu- dents.[4-6] Although several studies have used nationwide al had more than three outpatient visit or one admission claim or registered database to overcome these limitation for proximal humerus fracture, the patient was followed of studies from limited regional database, the most studies from the first event and recounted if a further event occurr- have been performed only in western country.[7-10] ed 6 months or longer after the original visit or admission. The purpose of this study was to investigate the incidence [13] We followed each patient by code to identify death of proximal humerus fracture and its mortality following a date of eligible file using the KNHI Program. proximal humerus fracture in Korean people over 50 years of age using recent five year national claim data. RESULTS METHODS 1. Incidence of proximal humerus fracture Proximal humerus fracture increased by 40.5% over the The Korean National Health Insurance (KNHI) data covers 5 year of study (10,135 in 2008 and 14,238 in 2012) whereas 100% of the population including 97% health insurance the number of individuals 50 years or older in general pop- and 3% medical aid. All clinics and hospitals submit data ulation increased 19.5% (13,103,814 in 2008 and 15,657,674 on inpatients and outpatients, including data on diagnosis in 2012) (Table 1). Although the annual incidence of proxi- and medical costs, for claims. mal humerus fracture did not increase consistently, the in- One or more claims listing an International Classification cidence of proximal humerus fracture showed increasing of Disease (ICD), tenth revision diagnosis code of S42.2 (frac- tendency. The incidence of proximal humerus fracture increa- ture of upper end of humerus), S42.3 (fracture of shaft of sed from 104.7/100,000 in 2008 to 124.7/100,000 in 2012 humerus) was required for inclusion in this study. No dis- in women and from 45.3/100,000 in 2008 to 52.0/100,000 tinction was made between high energy and low energy in 2012 in men, respectively. In terms of the gender-specif- injury. ic distribution of proximal humerus fracture from 2008 to The data were evaluated to determine the incidence of 2012, the incidence of proximal humerus fracture in wom- proximal humerus fracture and mortality associated with en (19.1%) was more increased than that in men (14.8%) proximal humerus fracture, in men and women aged 50 (Fig. 1). The mean age specific incidence by 10 year age years or older from 2008 through 2012. groups increased in all age groups. In terms of age specific All data of Korean men and women over the age of 50 distribution of proximal humerus fracture from 2008 to years was based on the web site of the Korean Statistical 2012, the incidence of proximal humerus fracture increased Information Service.[11] Age standardized incidence rates of people in the corresponding of the age specific incidence Men Women Total 140 124.7 rates of people in the corresponding age groups in a stan- 118.8 118.5 120 109.7 dard population, which was estimated for the Caucasian 104.7 population in the United States (US) on July 1, 2008.[12] 100 90.9 87.0 86.4 80.5 80 77.3 Table 1. Incidence of proximal humerus fractures among patients 50 years or older from 2008 to 2012 60 50.1 49.3 52.0 45.3 46.5 Number of proximal humerus Incidence of proximal hu- (Person/100,000) 40 Year fracture merus fracture (per 100,000) 20 Total Men Women Total Men Women 2008 10,135 2,736 7,399 77.3 45.3 104.7 0 2008 2009 2010 2011 2012 2009 11,037 2,944 8,093 80.5 46.5 109.7 Year 2010 12,468 3,319 9,149 87.0 50.1 118.8 2011 12,967 3,434 9,533 86.4 49.3 118.5 Fig. 1. Gender specific incidence of proximal humerus fractures in 2012 14,238 3,784 10,454 90.9 52.0 124.7 patients aged 50 years or older from 2008 through 2012. 18 http://e-jbm.org/ http://dx.doi.org/10.11005/jbm.2015.22.1.17 Epidemiology of Proximal Humerus Fracture in Korea 80-100 60-69 4.5 70-79 50-59 Women 600 4.0 Men 259.8 247.7 246.6 3.5 Total 500 235.1 227.6 3.0 400 2.5 2.0 300 146.2 152.7 137.7 142.0 1.5 129.2 Mortality rate (%) 200 1.0 (Person/100,000) 75.8 76.8 0.5 70.1 74.2 77.9 100 0 38.8 40.1 44.4 46.2 48.2 3 6 9 12 0 Months 2008 2009 2010 2011 2012 Year Fig. 3. Mortality rate after proximal humerus fracture in 2011. Fig. 2. Age specific incidence of proximal humerus fractures in pa- tients aged 50 years or older from 2008 through 2012. DISCUSSION Table 2. One year mortality rate (%) after proximal humerus fracture To our knowledge, this is the first nationwide study of among patients 50 years or older from 2008 to 2012 proximal humerus fracture 50 year or older in South Korea Number of deaths after Mortality rate of proximal in terms of its incidence and mortality. We reported that Year proximal humerus fracture humerus fracture (%) the proximal humerus fracture in elderly patient was re- Total Men Women Total Men Women cently increasing and was associated with the high mortal- 2008 813 294 519 8.02 10.75 7.01 2009 866 288 578 7.85 9.78 7.14 ity in South Korea although hip fracture is associated with 2010 934 311 623 7.49 9.37 6.81 the highest mortality in elderly population.