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Byline: K. MichaA< Keywords: Key words: Cervical -- Estrogen -- Height -- Hip fracture -- Trochanteric Abstract: The two types of hip fracture -- cervical and trochanteric femoral fractures -- are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case--control study in Swedish women, 50--81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15--1.32) compared with an OR of 1.06 (95% CI 0.97--1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0.91--0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12--1.95) for trochanteric fractures and 1.22 (95% CI 0.98--1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0.55 (95% CI 0.33--0.92) compared with 1.00 (95% CI 0.71--1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions. Author Affiliation: (1) Department of Surgery, University Hospital, Uppsala, Sweden, SE (2) Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden, SE (3) Division of Epidemiology, Karolinska Hospital, Stockholm, Sweden, SE (4) Departments of Medicine and Community &amp Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA, US (5) Vasa Hospital, Gothenburg, Sweden, SE (6) Department of Orthopedics, Halmstad, Sweden , SE (7) Department of Medical Sciences, University Hospital, Uppsala, Sweden, SE Article note: Received: 22 March 1999 / Accepted: 28 May 1999

Background: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting.Methods: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18-64, 65-74, 75-84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency.Results: 105,043 patients were registered at 86 hospitals. 79,689 patients (76%) were treated in stroke units and 25,354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months.Conclusions: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care. [ABSTRACT FROM AUTHOR]