Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents.

The paper describes state-level averages and does not show which resident or facility factors explain the differences. The rates were adjusted only for age, sex, and race. The authors state they did not account for differences in resident populations by state, such as medication use and comorbid disease, or for nursing home characteristics such as staff-to-resident ratio. The sample was limited to long-stay residents enrolled in fee-for-service Medicare, so it may not apply to short-stay residents or residents not covered by fee-for-service Medicare. Hip fractures were identified from Medicare Part A claims coding, so fractures not coded in the claims may not be counted.

The authors declared no conflicts of interest.

Do not read the higher fall and antipsychotic medication percentages as proof that these factors cause more hip fractures. The study only described state-level variation and did not adjust for resident or facility differences.