Impact of Chronic Obstructive Pulmonary Disease on Mortality Rates After Hip Pertrochanteric Fracture: A Nationwide Population-Based Cohort Study.

Purpose: Hip fractures are a major public health concern, especially among older adults. Chronic obstructive pulmonary disease (COPD) is a famous comorbidity that can increase post-fracture outcomes. This retrospective population-based cohort study evaluated the impact of COPD on mortality and contralateral hip fracture risk following pertrochanteric fracture. Patients and Methods: We included patients diagnosed with pertrochanteric fracture (ICD-10-CM S72.1) between January 1, 2016, and December 31, 2022, from Taiwan's National Health Insurance Research Database. Mortality risk was assessed using Cox proportional hazards models, adjusted for sex, age, and Charlson Comorbidity Index (CCI) score. Contralateral hip fracture risk was estimated using competing risk analysis with death as a competing event. Subgroup analyses were stratified by sex, age, and CCI group. Results: After adjustment, COPD was significantly associated with higher 1-year mortality (AHR: 1.12, 95% CI: 1.06-1.19, p<0.0001). Conversely, COPD patients had a lower 1-year incidence of contralateral hip fracture compared with non-COPD patients (3.12% vs 4.40%; adjusted subdistribution HR: 0.70, 95% CI: 0.61-0.81, p<0.0001). Similar patterns were observed across all subgroups. Conclusion: COPD is an independent predictor of increased 1-year mortality after pertrochanteric fracture. The observed reduction in contralateral fracture risk likely reflects the competing risk of early mortality. These findings suggest that elderly patients with COPD should pay more attention in post-hip fracture management with personalized rehabilitation strategies.