Aims To determine if patient ethnicity among patients with a hip fracture influences the type of fracture, surgical care, and outcome. Methods This was an observational cohort study using a linked dataset combining data from the National Hip Fracture Database and Hospital Episode Statistics in England and Wales. Patients' odds of dying at one year were modelled using logistic regression with adjustment for ethnicity and clinically relevant covariates. Results A total of 563,640 patients were included between 1 April 2011 and 1 October 2020. Of these, 476,469 (85%) had a coded ethnicity for analysis. Non-white patients tended to be younger (mean 81.2 vs 83.0 years), and were more commonly male (34.9% vs 28.5%; p < 0.001). They were less likely to be admitted from institutional care (12.9% vs 21.8%; p < 0.001), to have normal cognition (53.3% vs 62.0%; p < 0.001), and to be free of comorbidities (22.0% vs 26.8%; p < 0.001), but were more likely to be from the most deprived areas (29.4% vs 17.3%; p < 0.001). Non-white patients were more likely to experience delay to surgery for medical reasons (14.8% vs 12.7%; p < 0.001), more likely to be treated with an intramedullary nail or a sliding hip screw (52.5% vs 45.1%; p < 0.001), and less likely to be mobilized by the day after surgery (74.3% vs 79.0%; p < 0.001). Mortality was higher among non-white inpatients (9.2% vs 8.4% for white), but was lower at one year after hip fracture (26.6% vs 30.3%). Conclusion Our study identified serious problems with the quality of NHS ethnicity data. Despite this, we have shown that there is complex variation in case-mix and hip fracture morphology between ethnic groups. We have also identified variations in care received between ethnic groups, and that disparities in healthcare may contribute to poorer outcome. Inpatient mortality is higher in non-white patients, although this finding reverses after discharge, and one-year mortality is lower. Patients from ethnic minority backgrounds experience disparities in healthcare, however at one year postoperatively non-white patients have a statistically significant lower mortality after controlling for relevant clinical covariates.

中文翻译：

---

英格兰和威尔士种族对髋部骨折后护理和结果的影响。


目的 确定髋部骨折患者的患者种族是否会影响骨折的类型、手术护理和结果。方法 这是一项观察性队列研究，使用链接数据集，结合了来自国家髋部骨折数据库和英格兰和威尔士医院发作统计的数据。使用 logistic 回归对患者一年内死亡的几率进行建模，并调整种族和临床相关协变量。结果 2011 年 4 月 1 日至 2020 年 10 月 1 日期间共纳入 563,640 例患者。其中，476,469 人 （85%） 有一个编码的种族进行分析。非白人患者往往更年轻 （平均 81.2 岁 vs 83.0 岁），男性更常见 （34.9% vs 28.5%;p < 0.001）。他们不太可能从机构护理中入院（12.9% 对 21.8%;p < 0.001），认知能力正常（53.3% 对 62.0%;p < 0.001），并且没有合并症（22.0% 对 26.8%;p < 0.001），但更有可能来自最贫困的地区（29.4% 对 17.3%;p < 0.001）。非白人患者更有可能因医疗原因延迟手术（14.8% 对 12.7%;p < 0.001），更有可能用髓内钉或滑动髋螺钉治疗（52.5% 对 45.1%;p < 0.001），并且不太可能在手术后第二天活动（74.3% 对 79.0%;p < 0.001）。非白人住院患者的死亡率较高 （9.2% vs 白人为 8.4%），但在髋部骨折后一年内死亡率较低 （26.6% vs 30.3%）。结论 我们的研究发现了 NHS 种族数据质量的严重问题。尽管如此，我们已经表明，种族之间的病例混合和髋部骨折形态存在复杂的差异。 我们还确定了不同种族群体之间接受的护理差异，以及医疗保健的差异可能导致较差的结局。非白人患者的住院死亡率更高，尽管这一发现在出院后发生逆转，并且 1 年死亡率较低。来自少数族裔背景的患者在医疗保健方面存在差异，但在控制相关临床协变量后，非白人患者术后一年的死亡率具有统计学意义。