38 to 1.64 (Table 2). We used SMR to compare indirectly the mortality of subjects after hip fracture to that of the general population in Taiwan. The overall annual SMR gradually decreased from 13.80

to 2.98 from 1999 to 2009 (Table 2). The 1-month, 3-month, 6-month, 1-year, 2-year, 3-year, 5-year and 10-year Metformin mortality rates were respectively 2.49%, 6.45%, 10.40%, 16.32%, 25.84%, 33.40%, 44.12%, and 53.50% for the whole cohort (Table 3). Moreover, the 1-month, 3-month, 6-month, 1-year, 2-year, 3-year, 5-year, and 10-year mortality rates were respectively 3.30%, 8.44%, 13.33%, 20.67%, 31.56%, 39.69%, 50.60%, and 59.25% for males and 1.96%, 5.17%, 8.51%, 13.50%, 22.15%, 29.33%, 39.92%, and 49.78% for females (Table 3). Males always exhibited higher mortality rates than females (Table 3, Fig. 1). We also calculated short- to long-term follow-up SMRs to compare indirectly the mortality of subjects after hip fracture to that of the general population Buparlisib in Taiwan. The overall SMRs at 1-year, 2-year, 3-year, 5-year, and 10-year after hip fracture were 9.67, 5.28, 4.16, 3.31 and 2.89, respectively (Table 4). The overall SMR was higher at the first year after fracture,

dropped at the second year, and decreased slowly after the second year to the 10th year after fracture. We also calculated gender-by-age stratified SMRs, which showed that females had a higher SMR in the younger age groups (60 years to 69 years) but lower Racecadotril SMR in the older age groups (greater than or equal to 80 years) compared with males. Overall, the youngest female age group (60 years to 64 years) had the highest SMRs (SMR of 34.75 at the first year and SMR of 4.38 at the tenth year) (Table 4). Long-term survival rate stratified by gender, age, type of hip fracture,

and the value of CCI is shown in Fig. 1. Statistically significant risk factors of overall death were male, older age, trochanteric fracture, and a large value of number of CCI. Ours is the first population study that reported on the excess mortality of subjects after hip fracture in Taiwan. The annual mortality of subjects after hip fracture decreased gradually during the study period. The annual SMR decreased gradually from 1999 to 2003 and declined pronouncedly from 2004 to 2009. This may be accounted for by the launch of the national insurance program in 1995, which improved the health care services that were available in Taiwan. This general improvement in health care, as well as the year-by-year improvement to surgical techniques, explains the decrease in peri-operative mortality and short-term post-operative mortality prior to 2002/2003. The rapid decline in mortality for hip fracture patients after 2002/2003 may be due to the fact that Taiwan’s health insurance program began using a case payment system on a wide scale in 2002, which allowed for better funding for hip fracture patients and more complete care to be provided.