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Figure.
Age-Adjusted Mortality Rates From Falls Among Persons Aged 75 Years or Older in the United States, 2000-2016
Age-Adjusted Mortality Rates From Falls Among Persons Aged 75 Years or Older in the United States, 2000-2016
Table.  
Mortality Rates From Falls and the Annual Percentage Change (APC) Among Persons Aged 75 Years or Older in the United States, 2000-2016
Mortality Rates From Falls and the Annual Percentage Change (APC) Among Persons Aged 75 Years or Older in the United States, 2000-2016
1.
Bergen  G, Stevens  MR, Burns  ER.  Falls and fall injuries among adults aged ≥65 years—United States, 2014.  MMWR Morb Mortal Wkly Rep. 2016;65(37):993-998. doi:10.15585/mmwr.mm6537a2PubMedGoogle ScholarCrossref
2.
Florence  CS, Bergen  G, Atherly  A, Burns  E, Stevens  J, Drake  C.  Medical costs of fatal and nonfatal falls in older adults.  J Am Geriatr Soc. 2018;66(4):693-698. doi:10.1111/jgs.15304PubMedGoogle ScholarCrossref
3.
Hartholt  KA, van Beeck  EF, van der Cammen  TJM.  Mortality from falls in Dutch adults 80 years and older, 2000-2016.  JAMA. 2018;319(13):1380-1382. doi:10.1001/jama.2018.1444PubMedGoogle ScholarCrossref
4.
Padrón-Monedero  A, Damián  J, Pilar Martin  M, Fernández-Cuenca  R.  Mortality trends for accidental falls in older people in Spain, 2000-2015.  BMC Geriatr. 2017;17(1):276. doi:10.1186/s12877-017-0670-6PubMedGoogle ScholarCrossref
5.
US Census Bureau. American Community Survey and Decennial Census (2000-2016). https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed April 22, 2019.
6.
Cheng  X, Wu  Y, Yao  J, Schwebel  DC, Hu  G.  Mortality from unspecified unintentional injury among individuals aged 65 years and older by US state, 1999-2013.  Int J Environ Res Public Health. 2016;13(8):E763. doi:10.3390/ijerph13080763PubMedGoogle ScholarCrossref
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Research Letter
June 4, 2019

Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016

Author Affiliations
  • 1Department of Surgery-Traumatology, Reinier de Graaf Groep, Delft, the Netherlands
  • 2US Centers for Disease Control and Prevention, Atlanta, Georgia
  • 3Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA. 2019;321(21):2131-2133. doi:10.1001/jama.2019.4185

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).

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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Article Information

Accepted for Publication: March 19, 2019.

Corresponding Author: Klaas A. Hartholt, MD, PhD, Reinier de Graaf Groep, Reinier de Graafweg 5, 2626 AD Delft, the Netherlands (k.hartholt@rdgg.nl).

Author Contributions: Dr Hartholt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hartholt, Lee, van Beeck.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Hartholt, Lee, van Beeck.

Critical revision of the manuscript for important intellectual content: Lee, Burns, van Beeck.

Statistical analysis: Hartholt, Lee.

Supervision: Lee, van Beeck.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

References
1.
Bergen  G, Stevens  MR, Burns  ER.  Falls and fall injuries among adults aged ≥65 years—United States, 2014.  MMWR Morb Mortal Wkly Rep. 2016;65(37):993-998. doi:10.15585/mmwr.mm6537a2PubMedGoogle ScholarCrossref
2.
Florence  CS, Bergen  G, Atherly  A, Burns  E, Stevens  J, Drake  C.  Medical costs of fatal and nonfatal falls in older adults.  J Am Geriatr Soc. 2018;66(4):693-698. doi:10.1111/jgs.15304PubMedGoogle ScholarCrossref
3.
Hartholt  KA, van Beeck  EF, van der Cammen  TJM.  Mortality from falls in Dutch adults 80 years and older, 2000-2016.  JAMA. 2018;319(13):1380-1382. doi:10.1001/jama.2018.1444PubMedGoogle ScholarCrossref
4.
Padrón-Monedero  A, Damián  J, Pilar Martin  M, Fernández-Cuenca  R.  Mortality trends for accidental falls in older people in Spain, 2000-2015.  BMC Geriatr. 2017;17(1):276. doi:10.1186/s12877-017-0670-6PubMedGoogle ScholarCrossref
5.
US Census Bureau. American Community Survey and Decennial Census (2000-2016). https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed April 22, 2019.
6.
Cheng  X, Wu  Y, Yao  J, Schwebel  DC, Hu  G.  Mortality from unspecified unintentional injury among individuals aged 65 years and older by US state, 1999-2013.  Int J Environ Res Public Health. 2016;13(8):E763. doi:10.3390/ijerph13080763PubMedGoogle ScholarCrossref
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