Temporal trends and patterns in mortality from falls across 59 high-income and upper-middle-income countries, 1990-2021, with projections up to 2040: a global time-series analysis and modelling study.

Abstract

Background: Deaths related to falls are a substantial public health problem worldwide, and insight into trends and differences in global fall-related deaths can be valuable for identifying prevention strategies and developing effective policies. Thus, we aimed to estimate global fall-related mortality rate trends and forecast future fall-related deaths.

Methods: In this global time-series analysis and modelling study, we investigated temporal trends in fall-related mortality rates from 1990 to 2021 using the WHO Mortality Database, following the GATHER guidelines, and forecasted trends until 2040 across 59 high-income and upper-middle-income countries. We focused on identifying specific patterns of variation in mortality rates across different age groups, sexes, and income levels based on World Bank country classification. We analysed temporal trends and patterns using a locally weighted scatter plot smoother curve presented by age-standardised mortality rates (ASMRs), and future projections were calculated based on Bayesian age-period-cohort analysis. We performed a decomposition analysis to identify variations in fall-related deaths by examining factors such as population growth, ageing, and epidemiological changes.

Findings: Fall-related mortality rates per 100 000 people declined from 23·21 (95% CI 21·30 to 25·12) in 1990 to 11·01 (9·94 to 12·08) in 2009, increasing to 12·50 (10·36 to 14·64) by 2021. Throughout the period from 1990 to 2021, fall-related mortality rates were consistently higher among men, individuals in high-income countries, and older adults. The results represent a clear pattern in fall-related mortality rates according to sex, income level, and age group. ASMRs exhibited varying patterns, with an initial decrease of 43·83% (from 11·54 [95% CI 9·33 to 13·76] in 1990 to 6·48 [95% CI 5·28 to 7·68] in 2005) in upper-middle-income countries with a subsequent rise of 49·69% to 9·70 (9·33 to 13·76) in 2021, with a 17·81% increase among women (from 9·04 in 2009 to 10·65 in 2021), and with a 1434·8% increase in individuals aged 85 years and older (from 5·00 [-4·94 to 14·94] in 1992 to 76·74 [62·10 to 91·39] in 2021). Furthermore, ASMRs showed a positive correlation with Socio-demographic Index (β=42·29 [10·26 to 74·32]; p<0·011), the Environmental Performance Index (β=0·19 [0·05 to 0·33]; p=0·0090), and the reverse Gini coefficient (β=22·58 [0·45 to 44·72]; p=0·046). Projections indicate that the fall-related mortality rate is expected to rise from 14·80 (95% credible intervals, 14·04 to 15·59) per 100 000 people in 2021 to 19·48 (7·02 to 98·84) by 2040. The increase in fall-related deaths from 1990 to 2040 can be attributed to the growth in population, because the absolute number of fall-related deaths has risen despite a declining rate.

Interpretation: Temporal trend in fall-related deaths declined from 1990 to 2009, followed by an increase in 2021. Fall-related deaths among women and individuals aged 85 years and older will continue to increase until 2040, particularly in upper-middle-income countries. Urgent and proactive implementation of targeted interventions and prevention programmes is necessary to reduce fall-related mortality effectively.

Funding: National Research Foundation of Korea.