Incidence and number of hip fractures in South Africa: estimated projections from 2020 to 2050, August 2021
Hawley S, Dela S, Burton A, Paruk F, Cassim C, Gregson CG
Hip fracture is an established major public health problem among older adults in high-income settings; however, data from the sub-Saharan African region are scarce. Yet, this century, the number of older adults in sub-Saharan Africa is expected to grow faster than any other region globally. We aimed to use emerging data on hip fracture incidence in South Africa to estimate future burden of hip fracture for the country over the next three decades.
Previously collected data on hip fracture patients from eight districts within the Gauteng, KwaZulu-Natal and Western Cape regions of South Africa were re-analysed. All patients aged ≥40 years with a radiograph-confirmed hip fracture over a 12-month period in one of 94 included hospitals were enrolled. High-velocity trauma, pathological and peri-prosthetic fractures were excluded. Age-, sex- and ethnicity-specific incidence rates were generated and standardised to the 2011 South African census population and to future South African population projections estimated by the United Nations (UN). A correction factor was applied to UN projections for the population size aged ≥80 years, derived from the under-estimated 2011 UN population size compared to the South African 2011 census.
The 2767 included hip fracture patients had mean (SD) age 73.7 (12.7) years; 69% were female. Incidence rates (per 100,000 people), standardised to the estimated South African population in 2020, were 104 for females and 47 for males. Rates for Black Africans (the largest ethnic group in South Africa; 79.2% of total population) were lower at 63 for females and 40 for males. Overall projected incidence rates were discernibly higher by the year 2040 (122 and 53 for females and males, respectively) and increased further by the year 2050 (141 and 60 for females and males, respectively). In terms of the overall annual number of hip fractures for the country, estimates increased from approximately 10,000 in 2020 to approximately 23,000 by 2050 (approximately 16,500 in Black Africans and approximately 6500 in other ethnic groups). The overall and age-stratified number of hip fractures are shown in the figure.
The hip fracture burden for South Africa, whose last census population was 52 million, is estimated to more than double over the next 30 years, to approximately one-third of those currently seen in the UK. Significant investment in fracture prevention services and inpatient fracture care is likely to be needed to meet this demand.
Healthcare costs of acute hip fractures in South Africa, August 2021
Mafirakureva, F. Paruk, B. Cassim, CL. Gregson, SM. Noble
Hip fractures are associated with high costs to healthcare systems in high-income countries. Despite rapidly ageing populations, data on healthcare costs in sub-Saharan Africa are limited. We aimed to estimate the direct healthcare costs associated with the acute management of hip fractures in the public healthcare system in South Africa (SA).
We conducted a micro-costing study to estimate the cost per patient treated for hip fracture in five regional public health hospitals in eThekwini, in KwaZulu-Natal (KZN), SA. Data for 200 consecutive patients presenting with a hip fracture, identified from orthopaedic admission registers, were collected prospectively. Resource data included staff time, consumables, blood tests, X-rays, theatre time, implants, medicines, and length of stay (LOS) from initial presentation up to discharge post-fracture. We valued the resources by multiplying the quantity used by the unit prices/costs, estimated from the KZN Department of Health hospital fees manual for 2019/20. Costs were measured in local currency and reported in 2020 prices.
The mean cost per patient for the acute management following an index hip fracture was R108,525 (SD=R64,076). The major cost driver was the surgical ward cost, R92,520 (SD=R63,058), largely driven by LOS (mean [SD]=21 days), contributing 85.3% of the total cost. The second greatest cost driver was theatre costs, R 11,606 (SD=R1,288), largely driven by implant costs, contributing 10.7%. Figure 1 shows the distribution of mean healthcare costs. Costs were approximately R4,000 higher in patients operated under spinal anaesthesia.
Healthcare costs following a hip fracture are high and may represent a significant economic burden to patients, the health system and society. As the population ages, this economic burden is expected to increase. Efforts to reduce fracture incidence and inpatient lengths of stay are warranted.
NIHR-Wellcome Partnership for Global Health Research (217135/Z/19/Z)
Unrestricted Educational grant from Servier® PTY (LTD)
UKZN competitive grant