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Numbers of acute care hospital patients for the 2003/2004 fiscal year are based on information extracted from the Health Person-oriented Database (HPOI), which is maintained by Statistics Canada. Records of individual patients were linked to produce patient-oriented data. The HPOI represents a subset of information from a national database of hospital discharge records, the Hospital Morbidity Database (HMDB). The HMDB is constructed annually and maintained by the Canadian Institute for Health Information. The reported number of hip fracture patients excludes those admitted to non-acute hospitals or acute-care settings that were not part of the Discharge Abstract Database (DAD) frame in 2003/2004 (e.g., psychiatric hospitals). This analysis used only HPOI records with valid person identifiers that were constructed, in part, from health insurance numbers. For the 2003/2004 fiscal year, less than 2% of the HPOI acute care discharge records for patients aged 60 or older did not have a valid person identifier.
The information on members of the household population who had sustained hip or other fractures is based on data from the 2003 Canadian Community Health Survey (CCHS), cycle 2.1. The CCHS covers the household population aged 12 or older in all provinces or territories, except residents of institutions, all members of the regular Armed Forces, people living on Indian reserves and some remote areas, and civilian residents of military bases. Cycle 2.1 began in January 2003 and ended in December that year. The response rate was 80.6%, yielding a sample of 135,573 respondents. More information on the CCHS can be found in a published report.4
A total of 34,743 respondents aged 60 or older provided information on their most serious injury and presence/absence of stroke effects; they represent an estimated 4.8 million people. Previous research indicates that the risk of hip fracture begins to increase substantially at age 60 (data not shown). In this analysis, several potentially confounding factors that may influence health or health care use were taken into account. Aspects of Andersen's behavioural model of medical care utilization5 were used to select pertinent variables available from the CCHS: sex, age, education and living arrangements, and presence of chronic conditions.
Variance on estimates and on differences between estimates was calculated using the bootstrap technique, which accounts for the complex sampling design of the survey.6,7
