Table 2. Unadjusted Incidence Rate and Adjusted Rate of Any Fracture and Hip Fracture Based on Inverse-Probability Weighted Cox Proportional Hazards Regression Among Medicare Beneficiaries With Primary Hyperparathyroidisma.
| Characteristic | Any fracture | Hip fracture | |||
|---|---|---|---|---|---|
| Unadjusted incidence rate (per 100 person-y) | Cox proportional hazards regression, IPW adjusted HR (95% CI) |
Unadjusted incidence rate (per 100 person-y) |
Cox proportional hazards regression, IPW adjusted HR (95% CI) |
||
| Treatment | |||||
| Nonoperative management | 3.19 | 1 [Reference] | 0.90 | 1 [Reference] | |
| Parathyroidectomy | 2.15 | 0.78 (0.76-0.80) | 0.57 | 0.76 (0.72-0.79) | |
| Sex | |||||
| Male | 1.66 | 1 [Reference] | 0.52 | 1 [Reference] | |
| Female | 3.17 | 1.41 (1.36-1.47) | 0.86 | 1.28 (1.19-1.37) | |
| Age group, y | |||||
| 66-75 | 1.80 | 1 [Reference] | 0.40 | 1 [Reference] | |
| 76-85 | 3.93 | 1.69 (1.64-1.74) | 1.16 | 2.37 (2.25-2.50) | |
| ≥86 | 6.76 | 2.41 (2.32-2.51) | 2.28 | 4.04 (3.77-4.34) | |
| Race or ethnicity | |||||
| American Native | 2.69 | 0.98 (0.75-1.27) | 0.52 | 0.78 (0.46-1.33) | |
| Asian | 2.12 | 0.70 (0.61-0.80) | 0.55 | 0.73 (0.56-0.93) | |
| Black | 1.21 | 0.44 (0.42-0.47) | 0.36 | 0.42 (0.37-0.47) | |
| Hispanic | 3.01 | 0.90 (0.81-1.01) | 0.87 | 0.79 (0.63-0.98) | |
| White | 3.05 | 1 [Reference] | 0.84 | 1 [Reference] | |
| Unknown | 1.72 | 0.62 (0.53-0.72) | 0.43 | 0.53 (0.39-0.73) | |
| ADI group | |||||
| Most advantaged | 2.91 | 1 [Reference] | 0.77 | 1 [Reference] | |
| Slightly advantaged | 2.86 | 1.03 (1.00-1.07) | 0.79 | 1.09 (1.03-1.16) | |
| Slightly disadvantaged | 2.85 | 1.04 (1.00-1.07) | 0.81 | 1.14 (1.07-1.21) | |
| Most disadvantaged | 2.68 | 1.82 (1.03-1.13) | 0.81 | 1.28 (1.17-1.39) | |
| Geography | |||||
| Urban | 2.86 | 1 [Reference] | 0.79 | 1 [Reference] | |
| Rural | 2.80 | 1.03 (1.00-1.07) | 0.80 | 1.04 (0.98-1.11) | |
| Frailty | |||||
| Robust | 1.74 | 1 [Reference] | 0.49 | 1 [Reference] | |
| Prefrail | 3.12 | 1.40 (1.36-1.45) | 0.85 | 1.29 (1.22-1.37) | |
| Mildly frail | 5.68 | 1.98 (1.89-2.07) | 1.56 | 1.89 (1.74-2.05) | |
| Moderately-to-severely frail | 5.55 | 1.80 (1.70-1.91) | 1.53 | 1.80 (1.62-2.01) | |
| Charlson-Deyo Comorbidity Index score | |||||
| 0 | 2.16 | 1 [Reference] | 0.62 | 1 [Reference] | |
| 1 | 2.67 | 1.10 (1.06-1.14) | 0.75 | 1.07 (0.99-1.15) | |
| ≥2 | 3.25 | 1.16 (1.12-1.20) | 0.89 | 1.11 (1.04-1.18) | |
| Operative indications for parathyroidectomy | |||||
| History of osteoporosis | 4.31 | 1.66 (1.62-1.71) | 1.11 | 1.40 (1.33-1.47) | |
| History of kidney stones | 2.65 | 0.96 (0.92-0.99) | 0.69 | 0.92 (0.86-0.99) | |
| History of stage 3 CKD | 3.03 | 0.93 (0.89-0.98) | 0.91 | 1.08 (1.00-1.17) | |
| Endocrinologist care ≤6 mo of diagnosis | 2.81 | 0.97 (0.95-0.99) | 0.74 | 0.92 (0.88-0.97) | |
| Fracture risk factors | |||||
| Prior fracture | 9.01 | 2.34 (2.26-2.41) | 1.81 | 1.58 (1.48-1.68) | |
| Tobacco use | 3.65 | 1.38 (1.31-1.47) | 1.15 | 1.76 (1.59-1.94) | |
| Alcohol use disorder | 5.12 | 1.54 (1.37-1.74) | 1.34 | 1.55 (1.24-1.94) | |
| Obesity | 2.30 | 0.95 (0.90-0.99) | 0.48 | 0.76 (0.69-0.84) | |
Abbreviations: ADI, area deprivation index; CKD, chronic kidney disease; HR, hazard ratio; IPW, inverse probability weighted.
a
The propensity score used for the IPW was based on all characteristics listed.