To the Editor: In their observational study, Dr Leslie and colleagues1 reported that age-standardized rates of hip fractures have been steadily declining in Canada since 1985. The results of the study are based on data from the Hospital Morbidity Database (HMDB) of the Canadian Institute for Health Information (CIHI) from 1985 to 2005. When using electronic databases, knowledge of their validity is required; for hip fractures, databases might both overestimate and underestimate the incidence.2 Errors may arise at coding, entering, transferal, editing, and extraction of data, and the presence and influence of these errors might change over time.
Lofthus CM, Medhus AW, Meyer HE. Database Validity in Assessing Population Trends in Hip Fracture Rates in Canada. JAMA. 2010;303(2):134-135. doi:10.1001/jama.2009.1973