Epidemiology of Mortality Attributed to Falls in Older Adults in the US, 1999–2020

Abstract

Introduction

Falls, fall injury, death from falls, and fear of falling are highly prevalent specters in the lives of older adults and cost the US billions of dollars annually. Research has documented recent increases in mortality attributed to falls, yet it remains unclear how these trends vary by geography, season, and place of death. Understanding such epidemiology is necessary to describe risk factors in the geriatric population and inform work toward fall prevention. In this study, we sought to examine death certificate data from 1999 to 2020 to understand recent trends in fall mortality among older adults.

Methods

We examined the Centers for Disease Control and Prevention WONDER database for death certificates from 1999 to 2020, accounting for underlying cause of death ICD-10 codes of W00-W19. Trends were characterized using Joinpoint Regression Program, version 4.9.1.0 (National Cancer Institute). This program describes trend data using the simplest possible model, beginning with 0 joinpoints and testing significance at the addition of each joinpoint using Monte Carlo Permutation. Our analyses included all adults aged 65 years or older. State comparisons between 1999 and 2020 omitted Alaska and Washington D.C. due to suppressed data. The urbanization scale grouped National Center for Health Statistics classifications. This study examined deidentified data which are publicly available and therefore did not require institutional review board approval.

Results

The age-adjusted mortality rate (AAMR) of falls among adults aged 65 years or older rose nationally from 29.4 (95% CI 28.8–30.0) to 69.4 (95% CI 68.7–70.1) per 100,000 from 1999 to 2020. The median (IQR) AAMR among states was 31.4 (24.8–39.4) in 1999. This variation increased, with a median (IQR) AAMR of 76.6 (56.8–97.5) in 2020 (2020 AAMRs in Figure 1A). Monthly analysis showed a persistent difference in mortality across seasons, with summer (June–August) exhibiting the lowest deaths and winter (December–February) exhibiting the highest (median annual winter increase over summer 615 deaths, IQR 497–812) (Figure 1B). Place of death also demonstrated variation; the most common place of death was at an inpatient medical facility (7573 total deaths in 1999 [69.1%] and 18,276 in 2020 [50.9%]). However, both hospice facilities (suppressed in 1999, 5476 in 2020 [15.2%]) and decedents’ homes (875 in 1999 [8.0%] to 5279 in 2020 [14.7%]) increased markedly over time (Figure 1C). Analysis by urbanization found similar trends of increasing total deaths in large metro areas (4889 [48.4%] in 1999 to 17,923 [49.1%] in 2020), medium/small metro areas (3234 [32.0%] in 1999 to 12,451 [34.1%] in 2020), and rural areas (1974 [19.6%] in 1999 to 6134 [16.8%] in 2020) (Figure 1D). AAMR by urbanization is provided in Supplementary Table 1 for initial and final study year. Age-specific mortality rates exhibited sizeable increases for all cohorts examined, with the greatest increases noted in the cohort aged 85 years or older for both males (142.5 per 100,000 [95% CI 135.8–149.3] in 1999 to 329.6 [95% CI 322.3–336.8] in 2020) (Figure 1E) and for females (97.2 [95% CI 93.6–100.7] in 1999 to 269.8 [95% CI 264.8–274.7] in 2020) (Figure 1F).

The full study can be viewed at Journal of the American Geriatrics Society.

Crane, M. A., Lam, A., Christmas, C., Gemmill, A., & Romley, J. A. (2023). Epidemiology of mortality attributed to falls in older adults in the US, 1999-2020. Journal of the American Geriatrics Society.