The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

doi:10.1136/injuryprev-2019-043286

. 2020 Oct;26(Supp 1):i3-i11.

doi: 10.1136/injuryprev-2019-043286. Epub 2020 Jan 15.

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

Spencer L James¹, Lydia R Lucchesi², Catherine Bisignano², Chris D Castle², Zachary V Dingels², Jack T Fox², Erin B Hamilton², Nathaniel J Henry², Kris J Krohn², Zichen Liu², Darrah McCracken², Molly R Nixon², Nicholas L S Roberts², Dillon O Sylte², Jose C Adsuar³, Amit Arora^{4

5}, Andrew M Briggs^{6

7}, Daniel Collado-Mateo^{8

9}, Cyrus Cooper^{10

11}, Lalit Dandona^{2

12}, Rakhi Dandona^{2

12}, Christian Lycke Ellingsen^{13

14}, Seyed-Mohammad Fereshtehnejad^{15

16}, Tiffany K Gill¹⁷, Juanita A Haagsma¹⁸, Delia Hendrie¹⁹, Mikk Jürisson²⁰, G Anil Kumar¹², Alan D Lopez^{2

21}, Tomasz Miazgowski²², Ted R Miller^{19

23}, G K Mini^{24

25}, Erkin M Mirrakhimov^{26

27}, Efat Mohamadi²⁸, Pedro R Olivares²⁹, Fakher Rahim^{30

31}, Lidia Sanchez Riera^{32

33}, Santos Villafaina⁸, Yuichiro Yano³⁴, Simon I Hay^{2

35}, Stephen S Lim^{2

35}, Ali H Mokdad^{2

35}, Mohsen Naghavi^{2

35}, Christopher J L Murray^{2

35}

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA spencj@uw.edu.
² Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
³ Sport Science Department, University of Extremadura, Badajoz, Spain.
⁴ School of Science and Health, Western Sydney University, Sydney, NSW, Australia.
⁵ Oral Health Services, Sydney Local Health District, Sydney, NSW, Australia.
⁶ School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia.
⁷ Ageing and Life Course, World Health Organization (WHO), Geneva, Switzerland.
⁸ Sport Science Department, University of Extremadura, Cáceres, Spain.
⁹ Faculty of Education, Autonomous University of Chile, Talca, Chile.
¹⁰ Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.
¹¹ Department of Rheumatology, University of Oxford, Oxford, United Kingdom.
¹² Public Health Foundation of India, Gurugram, India.
¹³ Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
¹⁴ Norwegian Institute of Public Health, Oslo, Norway.
¹⁵ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
¹⁶ Division of Neurology, University of Ottawa, Ottawa, ON, Canada.
¹⁷ Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁸ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
¹⁹ School of Public health, Curtin University, Perth, Western Australia, Australia.
²⁰ Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
²¹ University of Melbourne, Melbourne, QLD, Australia.
²² Department of Hypertension, Pomeranian Medical University, Szczecin, Poland.
²³ Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.
²⁴ Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
²⁵ Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India.
²⁶ Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.
²⁷ Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan.
²⁸ Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran.
²⁹ Institute of Physical Activity and Health, Autonomous University of Chile, Talca, Chile.
³⁰ Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
³¹ Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
³² Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
³³ Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia.
³⁴ Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
³⁵ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.

PMID: 31941758
PMCID: PMC7571347
DOI: 10.1136/injuryprev-2019-043286

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

Spencer L James et al. Inj Prev. 2020 Oct.

. 2020 Oct;26(Supp 1):i3-i11.

doi: 10.1136/injuryprev-2019-043286. Epub 2020 Jan 15.

Authors

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA spencj@uw.edu.
² Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
³ Sport Science Department, University of Extremadura, Badajoz, Spain.
⁴ School of Science and Health, Western Sydney University, Sydney, NSW, Australia.
⁵ Oral Health Services, Sydney Local Health District, Sydney, NSW, Australia.
⁶ School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia.
⁷ Ageing and Life Course, World Health Organization (WHO), Geneva, Switzerland.
⁸ Sport Science Department, University of Extremadura, Cáceres, Spain.
⁹ Faculty of Education, Autonomous University of Chile, Talca, Chile.
¹⁰ Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.
¹¹ Department of Rheumatology, University of Oxford, Oxford, United Kingdom.
¹² Public Health Foundation of India, Gurugram, India.
¹³ Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
¹⁴ Norwegian Institute of Public Health, Oslo, Norway.
¹⁵ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
¹⁶ Division of Neurology, University of Ottawa, Ottawa, ON, Canada.
¹⁷ Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁸ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
¹⁹ School of Public health, Curtin University, Perth, Western Australia, Australia.
²⁰ Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
²¹ University of Melbourne, Melbourne, QLD, Australia.
²² Department of Hypertension, Pomeranian Medical University, Szczecin, Poland.
²³ Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.
²⁴ Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
²⁵ Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India.
²⁶ Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.
²⁷ Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan.
²⁸ Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran.
²⁹ Institute of Physical Activity and Health, Autonomous University of Chile, Talca, Chile.
³⁰ Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
³¹ Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
³² Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
³³ Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia.
³⁴ Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
³⁵ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.

PMID: 31941758
PMCID: PMC7571347
DOI: 10.1136/injuryprev-2019-043286

Abstract

Background: Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls.

Methods: Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records.

Results: Globally, the age-standardised incidence of falls was 2238 (1990-2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622-5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5-9.8) per 100 000 which equated to 695 771 (644 927-741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897-17 636 830) YLLs, 19 252 699 (13 725 429-26 140 433) YLDs and 35 940 787 (30 185 695-42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age.

Conclusions: This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.

Keywords: burden of disease; epidemiology; fall.

PubMed Disclaimer

Conflict of interest statement

Competing interests: SJ reports grants from Sanofi Pasteur outside the submitted work; AB reports personal fees from World Health Organization outside the submitted work; CC reports personal fees from Amgen, personal fees from Danone, personal fees from Eli Lilly, personal fees from GlaxoSmithKline, personal fees from Kyowa Kirin, personal fees from Medtronic, personal fees from Merck, personal fees from Nestle, personal fees from Novartis, personal fees from Pfizer, personal fees from Roche, personal fees from Servier, personal fees from Shire, personal fees from Takeda, and personal fees from UCB outside the submitted work.

Figures

**Figure 1**
Age-standardised incidence rates per 100 000 of falls, 2017, both sexes.

**Figure 2**
Age-standardised cause-specific mortality rate per 100 000 of falls, 2017, both sexes.

**Figure 3**
Ratio of age-standardised mortality to incidence rates, 2017, both sexes.

**Figure 4**
Age-standardised nature-of-injury composition of falls by region. TBI, traumatic brain injury; YLDs, years lived with disability.

**Figure 5**
Age-specific nature-of-injury composition of falls globally. TBI, traumatic brain injury; YLDs, years lived with disability.

See this image and copyright information in PMC

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References

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[1] GBD 2016 traumatic brain injury and spinal cord injury collaborators Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurol 2019;18:56–87. 10.1016/S1474-4422(18)30415-0 - DOI - PMC - PubMed

[2] GBD 2016 traumatic brain injury and spinal cord injury collaborators Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurol 2019;18:56–87. 10.1016/S1474-4422(18)30415-0 - DOI - PMC - PubMed

[3] Falls in older persons: Risk factors and patient evaluation - UpToDate. Available: https://www.uptodate.com/contents/falls-in-older-persons-risk-factors-an... [Accessed 12 Jun 2019].

[4] Falls in older persons: Risk factors and patient evaluation - UpToDate. Available: https://www.uptodate.com/contents/falls-in-older-persons-risk-factors-an... [Accessed 12 Jun 2019].

[5] Falls: Prevention in community-dwelling older persons - UpToDate. Available: https://www.uptodate.com/contents/falls-prevention-in-community-dwelling... [Accessed 12 Jun 2019].

[6] Falls: Prevention in community-dwelling older persons - UpToDate. Available: https://www.uptodate.com/contents/falls-prevention-in-community-dwelling... [Accessed 12 Jun 2019].

[7] Kyu HH, Abate D, Abate KH, et al. . Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1859–922. 10.1016/S0140-6736(18)32335-3 - DOI - PMC - PubMed

[8] Kyu HH, Abate D, Abate KH, et al. . Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1859–922. 10.1016/S0140-6736(18)32335-3 - DOI - PMC - PubMed

[9] Roth GA, Abate D, Abate KH, et al. . Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1736–88. 10.1016/S0140-6736(18)32203-7 - DOI - PMC - PubMed

[10] Roth GA, Abate D, Abate KH, et al. . Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1736–88. 10.1016/S0140-6736(18)32203-7 - DOI - PMC - PubMed

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The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

Affiliations

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

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Conflict of interest statement

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