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  • Fall-Related Injury and Death Remain Global Problems

    In this review: The global burden of falls: global, regional, and national estimates of morbidity and mortality from the Global Burden of Diseases Study 2017
    (BMJ, January, 2020)

    The Message
    Around the world, falls continue to pose a significant health care burden, but it's a burden that varies from region to region in a variety of ways, according to a recent analysis of global falls data from 2017. For example, the highest incidence rates for falls occur in Central Europe, Australia, and New Zealand, but that incidence doesn't correlate to higher falls-related mortality rates, which tend to surface in South Asia. And while age-standardized incidence of falls decreased slightly overall between 1990 and 2017, most of that decrease was accounted for in wealthier and more educated populations, while those in lower socio-demographic groupings actually experienced an increase in falls incidence.

    The Study
    Authors took a deep dive into data from the 2017 edition of the Global Burden of Disease Study, or GBD, a research effort that gathers information on hundreds of diseases in 195 countries and territories. The GBD amasses data not only on disease incidence and prevalence, but years lived with disability — YLD — mortality, and risk. For the BMJ study, researchers analyzed data related to falls, focusing on specific geographic areas, ages of those experiencing falls injury, and types of injuries sustained, among other data points.

    Findings

    • Overall, the age-standardized incidence of falls globally was 2,238 per 100,000 people in 2017 — a 3.7% decline from 1990 levels. The prevalence (rate of those who have sustained an injury from a fall over time, not just those who experienced a falls-related injury during 2017) rate was 5,186 per 100,000 in 2017, a 6.5% drop from 1990 rates.
    • Worldwide, incidence decreased by 8.8% between 1990 and 2017 for the highest socio-demographic group, but increased in the middle and lower groups.
    • The global age standardized mortality rate attributed to falls was 9.2 per 100,000 in 2017, which equated to nearly 700,000 deaths.
    • Central Europe led the world in falls incidence rates, averaging 11,434 falls per 100,000 people. Australia wasn't far behind, at 8,147 per 100,000, followed by Eastern Europe with an incidence rate of 8,187. The U.S. and Canada recorded incidence rates of between 3,000 to 4,000 per 100,000.
    • Falls-related mortality rates were highest in South Asia, with countries such as Cambodia, Myanmar, and Vietnam reporting that on average, more than 3 deaths occur for every 100 falls. The South Asia region as a whole registered a rate of 22 deaths per 100,000 people. Globally, total falls-related deaths have nearly doubled since 1990, authors report.
    • After adjusting for comorbidities and calculating YLD, researchers estimate that the average person who experienced a fall in 2017 lost 4% of her or his full-life status. In all regions studied, the leading cause of falls-related disability was a patella, tibia, fibular, or ankle fracture.

    Why It Matters
    The GBD estimates that falls are the 18th leading cause of age-standardized disability-adjusted life years, or DALYs — more than kidney disease, Alzheimer disease, and asthma. Additionally, falls are second only to auto/road injuries as the leading cause of accidental death.

    "Given that many fall incidents are preventable, occur in any population, and can lead to substantial morbidity and mortality," authors write, "it is surprising that falls do not draw more attention as an important global issue."

    More From the Study
    Authors believe that the wide variability in falls-related mortality "reveal that certain areas of the world likely have inadequate capabilities of responding to injurious falls." Given the aging world population, they add, "it is important for all countries to ensure that their older adult populations as well as their aging population share adequate access to caretaking and treatment resources now and in the future."

    As for the pockets of higher incidence and DALY rates, authors speculate that there may be two factors at play — a higher than average percentage of people living in rural areas, and an older-than-average population in those countries.

    Keep in mind …
    Authors point out that their study couldn't account for care-seeking behavior in various locations around the world. That may in turn affect incidence rate estimates, which they based on medical care records. Additionally, because their data was related to injury that led to medical care, authors concede that their mortality estimates may be slightly lower than if all falls were included. Finally, authors note that reporting to the GBD is not consistently reliable in all areas of the world.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.