Increased Risk of Infections and Mortality Following Fractures in Multiple Myeloma: A Nationwide Population‐Based Retrospective Cohort Study
Ching‐Chi Lee, Wei‐Yi Huang, Yu‐Fen Chen, I‐Szu Cheng, Kuo‐Yuan HuangABSTRACT
Background and Aims
To determine whether patients with MM face higher risks of hospitalized infections and long‐term all‐cause mortality after a first fracture than non‐MM fracture patients at the population level.
Methods
We performed a nationwide retrospective cohort study using Taiwan National Health Insurance Research Database from 2001 to 2019. Adults with MM and non‐MM adults with an index hospitalized fracture were identified and matched 1:10 by propensity scores. Cox proportional‐hazards models and Kaplan–Meier analyses compared risks of lower respiratory tract, reproductive or urinary tract, intra‐abdominal, and skin and soft‐tissue infections requiring hospitalization, as well as all‐cause mortality.
Results
During 2001–2019, the incidence and age‐standardized incidence of MM in Taiwan were 6.0 and 5.4 per 100,000 people, respectively, and both increased over time. After propensity‐score matching, 303 MM patients with a first hospitalized fracture were compared with 3,030 non‐MM fracture patients. Compared with matched non‐MM patients, MM patients had significantly higher risks of lower respiratory tract infections (adjusted hazard ratio [AHR] = 2.12, 95% confidence interval [CI]: 1.72–2.61; p < 0.001), reproductive or urinary tract infections (AHR = 1.40, 95% CI: 1.06–1.86; p = 0.019), and all‐cause mortality (AHR = 1.98, 95% CI: 1.72–2.28; p < 0.001). The corresponding incidence rates per 1,000 person‐years were also higher in MM than non‐MM patients for lower respiratory tract infections (237.96 vs. 60.92), reproductive or urinary tract infections (107.35 vs. 41.26), skin and soft‐tissue infections (28.77 vs. 15.30), and all‐cause mortality (271.67 vs. 84.39). These associations were generally consistent across subgroups stratified by age, sex, and fracture type.
Conclusion
MM was associated with substantially higher risks of serious infections and death after fracture. These findings support early multidisciplinary post‐fracture care, including infection surveillance and prevention, in MM patients.