Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan.
Stroke is a critical issue of physical disability. This study aimed to investigate the association of stroke subtypes and hip fracture by using the Taiwan National Health Insurance Research Database. Significantly higher risks of hip fracture were found for female gender and intracerebral hemorrhagic stroke patients.


INTRODUCTION
Previous studies reported the increased hip fracture (HF) after acute stroke. Increased falling tendency immobilization-related sarcopenia and underlying comorbidities are related to HF in stroke patients. In the present study, we explored the association of different stroke subtypes and several comorbidities with poststroke HF.


METHODS
A population-based study was conducted using National Health Insurance Research Database (NHIRD) of Taiwan. First, we identified 17,168 patients diagnosed as having a stroke between January 1, 2002, and December 31, 2010. Then, we randomly selected 51,504 controls that never had a stroke and matched these controls to stroke patients in a 1:3 ratio by age (± 1 year old) and gender. Cox proportional hazards model was used to estimate hazard ratio (HR) and 95% confidence interval (CI).


RESULTS
Stroke patients had a significantly higher risk of HF (HR = 1.69). Female and male stroke patients had incidence rate ratios (IRRs) of 2.05 and 1.82 for HF, respectively. Significantly increased IRRs of 1.82, 1.52, and 2.63 for HF were found for stroke patients with 0, 1, and ≥ 2 comorbidities, respectively. All stroke patients, ischemic stroke patients, and intracerebral hemorrhagic (ICH) patients had HF risks of 1.65, 1.60, and 2.34, respectively.


CONCLUSION
Overall, stroke significantly increases the incidence of HF, and the risk of HF is significantly higher in ICH patients and female gender. We should identify stroke patients at risk of HF and pay more attention to prevent them from fall in poststroke long-term care.
['Zheng|Jing-Quan|JQ|', 'Lai|Hui-Ju|HJ|', 'Zheng|Cai-Mei|CM|', 'Yen|Yu-Chun|YC|', 'Lu|Kuo-Cheng|KC|', 'Hu|Chaur-Jong|CJ|', 'Lee|Hsun-Hua|HH|', 'Wang|Yuan-Hung|YH|']
D000058:Accidental Falls D000368:Aged D016022:Case-Control Studies D002543:Cerebral Hemorrhage D015897:Comorbidity D016208:Databases, Factual D005260:Female D006620:Hip Fractures D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D016016:Proportional Hazards Models D018570:Risk Assessment D012307:Risk Factors D012737:Sex Factors D020521:Stroke D013624:Taiwan
Stroke Longitudinal health insurance database Post-stroke hip fracture Public health