Abstract
This study uses National Vital Statistics System data from 2000-2016 to characterize trends in mortality from falls in the US population aged 75 years or older.
In the United States, an estimated 28.7% of adults aged 65 years or older fell in 2014.1 Falls result in increased morbidity, mortality, and health care costs.1,2 Risk factors for falls include age, medication use, poor balance, and chronic conditions (ie, depression, diabetes).1 Fall prevention strategies are typically recommended for adults older than 65 years. In several European countries, an increase in mortality from falls has been observed since 2000, particularly among adults older than 75 years.3,4 This age group has the highest fall risk and potential for cost-effective interventions. We report trends in mortality from falls for the US population aged 75 years or older from 2000 to 2016.
Methods
Deaths from falls were extracted from the US National Vital Statistics System mortality files. These data are deidentified and publicly available; therefore, neither consent nor institutional review board review was required according to US federal regulations. Falls, defined as the underlying cause of death, were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes W00-W19. Unintentional deaths from falls for persons aged 75 years or older were collected between 2000 and 2016. Numbers of deaths from falls were specified for age and sex. Age-specific mortality rates were calculated in 5 age groups (75-79, 80-84, 85-89, 90-94, and ≥95 years). Age adjustment was performed by direct standardization to the 2000 US Census population and corrected for demographic changes throughout the study period. The mortality rate was expressed as cases per 100 000 persons aged 75 years or older. Age-specific population estimates overall and by sex, which are produced by the US Census Bureau each year, were used to calculate mortality rates.5 The annual percentage change (APC) in mortality from falls was modeled using a linear regression model with Poisson error and log link. A P < .05 (2-sided testing) was considered statistically significant. The analyses were performed using SPSS statistical software version 17.0.0 (IBM).
Results
The absolute number of deaths from falls among US adults aged 75 years or older increased from 8613 in 2000 to 25 189 in 2016 (Table). The crude mortality rate increased from 51.6 (95% CI, 50.5-52.7) per 100 000 persons in 2000 to 122.2 (95% CI, 120.7-123.7) per 100 000 persons in 2016 (Table). Age-adjusted mortality rates among adults aged 75 years or older increased significantly from 60.7 (95% CI, 58.8-62.7) per 100 000 men in 2000 to 116.4 (95% CI, 113.7-119.1) per 100 000 men in 2016 and from 46.3 (95% CI, 45.0-47.6) per 100 000 women in 2000 to 105.9 (95% CI, 103.9-107.8) per 100 000 women in 2016 (Figure). Mortality rates increased by age group. In 2016, persons aged 75 to 79 years old experienced a rate of 42.1 deaths (95% CI, 40.7-43.5) per 100 000 compared with 590.7 deaths (95% CI, 566.0-615.3) per 100 000 in persons aged 95 years or older. The APC for adults aged 75 years or older was 5.1% (95% CI, 5.0%-5.2%) and increased with age from 3.5% (95% CI, 3.3%-3.7%) in adults aged 75 to 79 years to 6.4% (95% CI, 6.2%-6.7%) in those aged 95 years or older (Table).
Table. Mortality Rates From Falls and the Annual Percentage Change (APC) Among Persons Aged 75 Years or Older in the United States, 2000-2016a.
| 2000 | 2004 | 2008 | 2012 | 2016 | APC for Trend (95% CI)c | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of Deaths/Population | Mortality Rate (95% CI)b | No. of Deaths/Population | Mortality Rate (95% CI)b | No. of Deaths/Population | Mortality Rate (95% CI)b | No. of Deaths/Population | Mortality Rate (95% CI)b | No. of Deaths/Population | Mortality Rate (95% CI)b | |||
| Aged ≥75 y | Overall | 8613/16 685 631 | 51.6 (50.5-52.7) | 12 644/17 535 786 | 72.1 (70.8-73.4) | 16 997/18 271 942 | 93.0 (91.6-94.4) | 20 858/19 152 403 | 108.9 (107.4-110.4) | 25 189/20 613 865 | 122.2 (120.7-123.7) | 5.1 (5.0-5.2) |
| Men | 3731/6 145 806 | 60.7 (58.8-62.7) | 5488/6 630 460 | 82.8 (80.6-85.0) | 7466/7 082 473 | 105.4 (103.0-107.8) | 8955/7 616 209 | 117.6 (115.1-120.0) | 10 994/8 401 717 | 130.9 (128.4-133.3) | 4.5 (4.4-4.7) | |
| Women | 4882/10 539 825 | 46.3 (45.0-47.6) | 7156/10 905 326 | 65.6 (64.1-67.1) | 9531/11 189 469 | 85.2 (83.5-86.9) | 11 903/11 536 194 | 103.2 (101.3-105.0) | 14 195/12 212 148 | 116.2 (114.3-118.1) | 5.5 (5.4-5.6) | |
| Aged 75-79 y | Overall | 1641/7 438 619 | 22.1 (21.0-23.1) | 2246/7 461 399 | 30.1 (28.9-31.3) | 2735/7 345 743 | 37.2 (35.8-38.6) | 2900/7 493 891 | 38.7 (37.3-40.1) | 3521/8 367 895 | 42.1 (40.7-43.5) | 3.5 (3.3-3.7) |
| Men | 895/3 056 882 | 29.3 (27.4-31.2) | 1189/3 140 080 | 37.9 (35.7-40.0) | 1451/3 167 246 | 45.8 (43.5-48.2) | 1518/3 293 629 | 46.1 (43.8-48.4) | 1947/3 723 619 | 52.3 (50.0-54.6) | 3.2 (2.9-3.5) | |
| Women | 746/4 381 737 | 17.0 (15.8-18.2) | 1057/4 321 319 | 24.5 (23.0-25.9) | 1284/4 178 497 | 30.7 (29.0-32.4) | 1382/4 200 262 | 32.9 (31.2-34.6) | 1574/4 644 276 | 33.9 (32.2-35.6) | 3.8 (3.5-4.1) | |
| Aged 80-84 y | Overall | 2200/4 984 540 | 44.1 (42.3-46.0) | 3436/5 528 504 | 62.2 (60.1-64.2) | 4272/5 730 359 | 74.6 (72.3-76.8) | 4876/5 780 040 | 84.4 (82.0-86.7) | 5214/5 865 639 | 88.9 (86.5-91.3) | 3.8 (3.6-4.0) |
| Men | 1052/1 853 013 | 56.8 (53.3-60.2) | 1669/2 111 081 | 79.1 (75.3-82.9) | 2113/2 252 413 | 93.8 (89.8-97.8) | 2394/2 355 610 | 101.6 (97.6-105.7) | 2595/2 453 255 | 105.8 (101.7-109.8) | 3.5 (3.2-3.7) | |
| Women | 1148/3 131 527 | 36.7 (34.5-38.8) | 1767/3 417 423 | 51.7 (49.3-54.1) | 2159/3 477 946 | 62.1 (59.5-64.7) | 2482/3 424 430 | 72.5 (69.6-75.3) | 2619/3 412 384 | 76.7 (73.8-79.7) | 4.1 (3.9-4.4) | |
| Aged 85-89 y | Overall | 2352/2 805 059 | 83.8 (80.5-87.2) |
3447/2 996 417 | 115.0 (111.2-118.9) | 4915/3 426 832 | 143.4 (139.4-147.4) | 6059/3 878 275 | 156.2 (152.3-160.2) | 7218/4 216 408 | 171.2 (167.2-175.1) | 3.7 (3.6-3.9) |
| Men | 992/882 868 | 112.4 (105.4-119.4) | 1465/985 297 | 148.7 (141.1-156.3) | 2172/1 185 695 | 183.2 (175.5-190.9) | 2650/1 400 060 | 189.3 (182.1-196.5) | 3249/1 583 610 | 205.2 (198.1-212.2) | 3.1 (2.9-3.3) | |
| Women | 1360/1 922 191 | 70.8 (67.0-74.5) | 1982/2 011 120 | 98.6 (94.2-102.9) | 2743/2 241 137 | 122.4 (117.8-127.0) | 3409/2 478 215 | 137.6 (132.9-142.2) | 3969/2 632 798 | 150.8 (146.1-155.4) | 4.2 (4.0-4.4) | |
| Aged 90-94 y | Overall | 1682/1 118 432 | 150.4 (143.2-157.6) | 2433/1 190 012 | 204.5 (196.3-212.6) | 3521/1 363 656 | 258.2 (249.7-266.7) | 4742/1 547 843 | 306.4 (297.6-315.1) | 6161/1 676 448 | 367.5 (358.3-376.7) | 5.4 (5.2-5.6) |
| Men | 592/284 376 | 208.2 (191.4-224.9) | 891/317 369 | 280.7 (262.3-299.2) | 1308/388 454 | 336.7 (318.5-355.0) | 1773/466 428 | 380.1 (362.4-397.8) | 2336/527 578 | 442.8 (424.8-460.7) | 4.7 (4.4-5.0) | |
| Women | 1090/834 056 | 130.7 (122.9-138.4) | 1542/872 644 | 176.7 (167.9-185.5) | 2213/975 203 | 226.9 (217.5-236.4) | 2969/1 081 415 | 274.5 (264.7-284.4) | 3825/1 148 870 | 332.9 (322.4-343.5) | 5.8 (5.6-6.0) | |
| Aged ≥95 y | Overall | 738/338 981 | 217.7 (202.0-233.4) | 1082/359 454 | 301.0 (283.1-318.9) | 1554/405 351 | 383.4 (364.3-402.4) | 2281/452 353 | 504.3 (483.6-524.9) | 3075/487 475 | 630.8 (608.5-653.1) | 6.4 (6.2-6.7) |
| Men | 200/68 667 | 291.3 (250.9-331.6) | 274/76 634 | 357.5 (315.2-399.9) | 422/88 665 | 475.9 (430.5-521.4) | 620/100 482 | 617.0 (568.5-665.6) | 867/113 655 | 762.8 (712.1-813.6) | 6.5 (6.0-7.0) | |
| Women | 538/270 314 | 199.0 (182.2-215.8) | 808/282 820 | 285.7 (266.0-305.4) | 1132/316 686 | 357.5 (336.6-378.3) | 1661/351 872 | 472.0 (449.3-494.7) | 2208/373 820 | 590.7 (566.0-615.3) | 6.4 (6.1-6.8) | |
The data are crude rates.
Per 100 000 population.
Significant in all groups at P < .001.
Figure. Age-Adjusted Mortality Rates From Falls Among Persons Aged 75 Years or Older in the United States, 2000-2016.
Discussion
An increasing age-adjusted trend in mortality from falls was observed among older US adults from 2000 to 2016. Mortality rates increased with age and throughout the study period. The APCs were highest among the oldest age groups. These finding are consistent with European data,3,4 although the mortality rates from falls were lower among the oldest old population in the United States compared with the Netherlands.3 This might be explained by differences between those countries in both the demographic composition (eg, the population share of non-Hispanic whites) and activity patterns (eg, rates of outdoor activities such as walking and cycling) of the older population.
The current study is based on nationally representative vital statistics. However, limitations exist. The age-adjusted rates were based on information from the US Census Bureau, which reports it might undercount persons aged 65 years or older; this could result in an overestimation of death rates. Misclassification or incomplete recording of cause of death is another concern that could overestimate or underestimate deaths from falls.6
The circumstances behind the increasing trends in mortality from falls are not fully understood. Future studies should focus on explaining the recent increase in mortality from falls, especially among the oldest age groups and what can be done to tailor interventions for these older age cohorts.
Section Editor: Jody W. Zylke, MD, Deputy Editor.
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