A decade of increasing complexity in patients sustaining a neck of femur fracture in England, Wales, and Northern Ireland:a national cohort study using the NHFD dataset

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Background Hip fractures (HF) are a major cause of morbidity and mortality and account for substantial health and social care costs. We report the incidence and characteristics of older patients (≥ 60 years) presenting with fractures of the proximal femoral neck in England, Wales, and Northern Ireland. Methods A national cohort study of HF events recorded in the National Hip Fracture Database (NHFD) between May 2011 and September 2023 were included. HF incidence was derived using sex and age-banded mid-year population estimates from the Office for National Statistics to calculate at-risk population incidence for the whole cohort and by sex and age strata. Results 735,460 HF events were included (70% female, mean age 82.9 years). Annual NHFD HF numbers increased across the study period 55,832 to 63,341 (13.5%). However, age-standardised incidence declined from 422.8 to 412.8 per 100,000 population. Divergence was observed between sexes, with falling incidence in females but rising in males. HF patients are presenting with greater systemic disease burden, with the proportion graded ASA ≥3 increasing in both females (66.4% to 80.4%) and males (73.4% to 84.3%). Conclusion Despite modest declines in age-standardised incidence in women, absolute hip fracture numbers continue to rise. The divergent sex-specific trends and substantial increase in patient comorbidity represent important shifts in hip fracture epidemiology with implications for service capacity, risk stratification, and secondary prevention strategies. This mandates urgent realignment of care resources to minimise the impact on patient mortality and economic health burden.

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