Journal of the American Medical Directors Association · Nov 5, 2026

Incidence, Temporal Trends, and Associated Characteristics of Hip Fracture in Long-Term Care Residents: A Population-Based Cohort Study in British Columbia

By Muhammad O, Whiting SJ, Rostami M et al.

Objectives To examine temporal trends in hip fracture incidence and determine whether resident-level or facility-level characteristics were associated with hip fracture occurrence among long-term care residents in British Columbia, Canada. Design Population-based retrospective cohort study. Setting and Participants A total of 33,739 adults aged ≥65 years newly admitted to 305 licensed long-term care facilities in British Columbia between 2010 and 2014. Methods Linked Canadian administrative health data integrated hospital discharge records with resident- and facility-level assessment data. Residents were followed from admission until first hip fracture, death, discharge, transfer, or administrative censoring. Hip fracture incidence rates were calculated per 100,000 person-years. Multivariable logistic regression examined resident-level and facility-level characteristics associated with hip fracture occurrence. Results Among 33,739 residents, 1914 (5.7%) sustained a first hip fracture, corresponding to an overall incidence rate of 3418 per 100,000 person-years. Annual incidence declined from 3830.5 per 100,000 person-years in 2010 to 3146.4 per 100,000 person-years in 2014, representing an 18% relative reduction. Independent characteristics associated with fracture occurrence included lower body mass index categories compared with obesity (adjusted odds ratio [aOR], 1.36-1.82), female sex (aOR, 1.61; 95% CI, 1.45-1.78), dementia (aOR, 1.46; 95% CI, 1.33-1.62), age 90 years and older (aOR, 1.34; 95% CI, 1.18-1.51), and recent falls (aOR, 1.15; 95% CI, 1.03-1.29). In contrast, facility size, rurality, and health region were not independently associated with fracture occurrence after adjustment for resident-level characteristics. Conclusions and Implications Hip fracture incidence declined modestly but remained substantial. Fracture occurrence was associated primarily with resident-level clinical characteristics rather than broad facility-level structural indicators. These findings support systematic identification of high-risk residents and suggest that fracture prevention efforts may be most effective when targeted toward low body mass index, dementia, advanced age, and recent falls.

doi.org/10.1016/j.jamda.2026.106513PubMed 42987451Populations