Hip Fractures in Adults with Schizophrenia: A Population-based Evaluation of the Burden and Quality of Care
Bibliographic record
Abstract
Hip fractures have life-altering consequences. Individuals with schizophrenia may experience a higher likelihood of hip fractures, worse postfracture outcomes, and suboptimal care. This thesis consisted of three distinct population-based studies which aimed to compare the burden of hip fractures, postfracture outcomes, and osteoporosis management among adults with and without schizophrenia in Ontario, leveraging observational study design methods, and multiple individually-linked administrative data sources. Using descriptive epidemiological methods, Study 1 characterized hip fractures in individuals with schizophrenia, by comparing sex-specific age-standardized rates and baseline characteristics to those without schizophrenia over a ten-year period. Analyses suggested that the age of onset for an index hip fracture is earlier among individuals with schizophrenia, particularly men. Annual age-standardized rates were threefold higher in men with vs without schizophrenia, and more than twofold higher in women. Study 2 investigated the association between schizophrenia and short- and long-term outcomes following hip fracture. Age- and sex-adjusted Kaplan-Meier survival curves suggested that individuals with schizophrenia were less likely to survive until 1-year following the index event. Age- and sex-adjusted GEE models suggested that schizophrenia was positively associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). The positive association between schizophrenia and readmissions (OR, 1.34; 95% CI, 1.20-1.50) persisted in fully adjusted multivariable models. In Fine-Gray competing risk models, schizophrenia was positively associated with subsequent hip fracture within two years (sdRH, 1.29; 95% CI, 1.09-1.53), with male hip fracture patients with schizophrenia sustaining a refracture 50 days earlier. Study 3 compared postfracture osteoporosis management between individuals with and without schizophrenia. Using Fine-Gray models, findings from Study 3 suggested that a schizophrenia diagnosis was associated with a lower incidence of bone mineral density testing and pharmacologic treatment for osteoporosis (sdRH, 0.79; 95% CI, 0.72-0.88), after accounting for important enabling and predisposing factors, and mortality as a competing risk. This thesis contributes important evidence to the sparse literature on hip fractures in individuals with schizophrenia. Findings have implications for fracture prevention, clinical management of bone health, and understanding how to best intervene across the full continuum of multidisciplinary care in order to optimize outcomes for this disadvantaged subpopulation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".