Incidence and cost of vertebral fracture in urban China: A five-year population-based cohort study

Background: Osteoporotic vertebral fractures cause pain and disability, which result in heavy socioeconomic burden. However, the incidence and cost of vertebral fractures in China are unknown. We aimed to assess the incidence and cost of clinically recognized vertebral fractures among people aged 50 years and older in China from 2013 to 2017. Materials and Methods: This population-based cohort study was conducted by using Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) data in China from 2013 to 2017, which covered more than 95% of the Chinese population in urban areas. Vertebral fractures were identified by the primary diagnosis (i.e., International Classification of Diseases code or text of diagnosis) in UEBMI and URBMI. The incidence and medical cost of these clinically recognized vertebral fractures in urban China were calculated. Results: A total of 271,981 vertebral fractures (186,428, 68.5% females and 85,553, 31.5% males) were identified, with a mean age of 70.26 years. The incidence of vertebral fractures among patients aged 50 years and over in China increased approximately 1.79-fold during the five years, from 85.21 per 100,000 person-years in 2013 to 152.13 per 100,000 person-years in 2017. Medical costs for vertebral fracture increased from US$92.74 million in 2013 to US$505.3 million in 2017. Annual costs per vertebral fracture case increased from US$3.54 thousand in 2013 to US$5.35 thousand in 2017. Conclusion: The dramatic increase in the incidence and cost of clinically recognized vertebral fracture among patients aged 50 and over in urban China implies that more attention should be given to the management of osteoporosis to prevent osteoporotic fractures.