Individuals were also excluded from the non-hip fracture cohort if they had a hip fracture on or within 2 years after their assigned index date. Third, all eligible individuals in the hip fracture cohort were matched on index date (month and fiscal year), age (±3 months), sex, and residence status (community vs. long-term care (LTC))

to non-hip fracture patients. Fourth, a propensity score for hip fracture was calculated using logistic regression according to collapsed aggregated diagnostic group (comorbidity score) [12], rurality index for Ontario (population density and access to health-care services score) [13], and income quintile. Finally, hip fracture patients find more were matched 1:1 to non-hip fracture individuals on the logit of the propensity score using a greedy matching algorithm with a maximum caliper width of 0.2 and no replacement [14]. We therefore hard

matched on age, sex, and residence status at index; all factors for which we were interested in providing stratified results; and then propensity score matched on comorbidity and sociodemographics that may impact health-care resource utilization. SBE-��-CD nmr Health-care costing and outcomes We used an Ontario health-care payer perspective, where only direct costs paid by the Ontario Ministry of Health and Long-Term Care were considered. When possible, all costs were applied based on the year they were incurred and then inflated and reported in 2010 Canadian dollars using the health-care component of the Ontario consumer price index (CPI, www.​statscan.​gc.​ca). Detailed methods for case-costing using administrative

databases in Ontario have recently been published [15]. In brief, Vitamin B12 acute hospitalizations, emergency department, and same day surgery costs were calculated using the resource intensity weight method that uses the average provincial costs per weighted case based on distinct case mix groups [16, 17]. Costing in complex continuing care was based on distinct resource utilization groups, case mix index, and number of days in care [18]. Physician service costs and prescription drug costs were based on the total amount paid to the physician/pharmacy from the Ministry of Health. Costs related to length of stay in rehabilitation were based on the rehabilitation patient group case mix classification and weighting system for Ontario [19–21]. Costs for home care were determined by applying an average cost per service (or hour) [22]. LTC costs were calculated based on the average cost per day and length of stay. In addition to health-care costs, we assessed the number of individuals who died, entered LTC, and experienced a second hip fracture. Statistical analysis Cohort characteristics were summarized using means and proportions. Balance between matched cohorts was assessed using standardized difference, where values <0.1 indicate balance [23].