Are hip fractures underestimated as a cause of death? The influence of coroners and pathologists on the death rate

In Trent Region the death rate from hip fractures based on Hospital Activity Analysis (HAA) figures is six times as high as the rate based on Office of Population Censuses and Surveys (OPCS) data. A previous study of Sheffield and Barnsley showed that the discrepancy in those health districts was due to a policy initiated by the coroner of ascribing deaths following hip fracture to osteoporosis on the death certificate. In the present study in Nottingham and North Derbyshire the hospital records of patients dying after a hip fracture (HAA data) were compared with the causes of death recorded on their death certificates. In Nottingham where the coroner usually ordered an autopsy but hardly ever an inquest the fracture was rarely mentioned on the death certificate as the underlying cause of death but was usually entered in Part II of the death certificate or not at all. In North Derbyshire where the coroner usually ordered both an autopsy and an inquest the fracture was much more often entered as the underlying cause of death. This resulted in the death rate based on OPCS data in North Derbyshire being much higher than in other Trent districts. It is concluded that the death rate from hip fracture based on OPCS data may be greatly influenced by the policy of coroners and the views of pathologists and that HAA data provides a more accurate measurement of the death rate of hip fracture which is much higher than OPCS data would suggest.