Global, regional, and national burden of falls among the elderly aged 65 and above: a systematic analysis based on the Global Burden of Disease Study 2021
ABSTRACT
Background:
Falls are a leading cause of injury, disability, and death among older adults, posing significant public health challenges. However, comprehensive global analyses of fall-related burdens in older populations remain scarce.
Objective:
To conduct a systematic analysis of the global burden of falls among older adults and address critical research gaps in understanding the overall burden, mortality burden, and disability burden associated with falls in this population.
Methods:
Data from the Global Burden of Disease (GBD) Study 2021 were used to assess the overall, disability, and mortality burdens of falls among adults aged ≥65. Age-standardized rates (ASRs) of Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) were calculated to compare burdens across countries. Health inequalities were evaluated via Slope Index of Inequality (SII) and Concentration Index (CI). Frontier analysis identified optimal burden levels by Socio-demographic Index (SDI). Spearman correlation linked fall burdens to aging-related indicators from WHO Ageing Data Portal. Bayesian Age-Period-Cohort models projected trends to 2050.
Results:
DALYs ASRs showed a U-shaped distribution across SDI regions: lower-SDI countries faced higher disability burdens, while higher-SDI countries had elevated mortality burdens. Despite an increase in absolute overall burden inequality from 1990 to 2021, absolute inequalities in YLDs and YLLs declined, with DALYs and YLDs exhibiting relatively more balanced distributions. Frontier analysis pinpointed countries with the greatest burden-reduction potential, while correlation analyses explored intervention targets. Projections suggest decreasing overall and mortality burdens by 2050 but rising disability burdens.
Conclusions:
Higher- and lower-SDI countries face distinct fall-related challenges. Reducing cross-national health inequalities and closing gaps between observed and SDI-ideal burden levels are critical. Despite projected declines in overall burden (DALYs), rising disability burden (YLDs) may present new challenges requiring targeted interventions.
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