Hip fracture incidence among Hispanic and Asian American elderl

Hip fractures represent a serious public health problem in the aging population. Internationally, rates of hip fracture vary widely. The risk of hip fracture in the elderly has been described in the United States using Medicare claims data from the Health Care Financing Administration (HCFA). While the Medicare data demonstrated significantly lower rates of hip fracture for Blacks compared to Whites, limitations in the race and ethnicity data available from Medicare have precluded similar investigations of hip fracture incidence for other minority groups: Hispanics and Asian Americans.;This study estimates age-sex-specific and age-adjusted hip fracture rates for Asian Americans and Hispanics. In 1994, HCFA added race/ethnicity codes for Hispanics, Asian Americans and Native Americans. Thus the first section of the dissertation evaluates the accuracy and completeness of these codes. The ethnic populations identifiable with the new codes for Hispanics and Asian Americans are much smaller than the census enumeration for those groups; and persons born in Asian and Hispanic places are not predominantly coded Asian and Hispanic. Thus these codes are not used to identify ethnic cohorts.;A cohort of 1992 Medicare enrollees, stratified by race/ethnicity code is followed for two years for a hospitalization record with a diagnostic code for hip fracture or for death. Ethnic cohorts are defined based on surname algorithms for Spanish, Chinese, Japanese and Korean surnames and Puerto Rican Social Security number issuance. Rates are derived with person-time denominators. On a national basis, Hispanics have hip fracture incidence rates intermediate between Black and White rates. However, geographic variation suggests that the aggregate rate masks significant variation by ancestry, with Puerto Ricans having a risk similar to Blacks while Mexican Americans have incidence rates almost as high as Whites. While all Asian groups have lower fracture incidence than Whites, Japanese have higher risk than Chinese. There is the suggestion that more recent Asian immigrants have higher hip fracture incidence than those either born in the United States or who immigrated earlier in life.