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A decade of increasing complexity in patients sustaining a hip fracture in England, Wales and Northern Ireland: a national cohort study using the National Hip Fracture Database dataset

Lookup NU author(s): Dr Richard Holleyman, Professor David Deehan

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society.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 hip fractures (HFs) in England, Wales and Northern Ireland. METHODS: We conducted a national cohort study of HF events recorded in the National Hip Fracture Database (NHFD) between May 2011 and September 2023. 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: 735 436 HF events were included (71% female, mean age 82.9 years). Annual NHFD HF numbers increased across the study period from 55 832 to 63 341 (13.5%). However, overall 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 American Society of Anaesthesiologists ≥3 increasing in both females (66.4% to 80.4%) and males (73.4% to 84.3%). CONCLUSION: Despite modest declines in overall incidence in women, absolute HF numbers continue to rise. The divergent sex-specific trends and substantial increase in patient comorbidity represent important shifts in HF 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.

Publication metadata

Author(s): Holleyman RJ, Baldock T, Charlett A, Baker P, Gregson CL, Judge A, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Age and ageing

Year: 2026

Volume: 55

Issue: 8

Online publication date: 11/08/2026

Acceptance date: 17/05/2026

Date deposited: 24/08/2026

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afag228

DOI: 10.1093/ageing/afag228

PubMed id: 42580692

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