Trends in Hip Fracture-Related Mortality Among Older Adults in the United States From 1999 to 2023: A Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Analysis

Background and aim Hip fractures are a major cause of morbidity and mortality among the aging U.S. population. Despite advances in preventive strategies and fracture management, mortality following hip fractures remains a critical public health concern. This study aimed to analyze the national trends in hip fracture-related mortality among adults aged 65 years and older in the United States from 1999 to 2023 using the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data. Methods We conducted a retrospective, population-based analysis using the CDC WONDER multiple cause-of-death database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the direct method standardized to the 2000 U.S. population. Joinpoint regression analysis was used to calculate annual percent changes (APCs) and identify significant shifts in mortality trends by sex, race/ethnicity, urbanization, U.S. census region, and state. Results Between 1999 and 2023, there were 334,905 hip fracture-related deaths among adults aged ≥65 years. The overall AAMR declined from 37.07 in 1999 to 23.91 in 2023. A significant decrease was observed from 2002 to 2018 (annual percent change (APC): -2.85%; 95% confidence interval (CI): -3.02 to -2.69; <i>p</i><0.001), with a more recent decline from 2021 to 2023 (APC: -4.37%; 95% CI: -8.23 to -0.33; <i>p</i>=0.036). Both men and women showed significant long-term mortality reductions, with men experiencing a steeper decline. Racial disparities were evident, with the largest declines among the American Indian or Alaska Native individuals (APC: -4.01%; <i>p</i><0.001). Non-metropolitan areas had higher mortality than metropolitan areas. Regionally, the Midwest had the highest AAMRs, while Montana, Colorado, and Minnesota recorded the highest state-level rates in 2023. Conclusion Hip fracture-related mortality among older adults in the United States has declined significantly over the past two decades, though recent trends suggest a plateau in some subgroups. Persistent disparities by race, sex, geography, and urbanization highlight the need for targeted public health interventions and equitable access to post-fracture care across the aging population.