Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

Background Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. Methods Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults). Findings Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13<middle dot>4 deaths per 100 000 population (95% uncertainty interval 13<middle dot>3-13<middle dot>6), an increase of 65<middle dot>3% (61<middle dot>9-68<middle dot>8) from 8<middle dot>1 deaths per 100 000 (8<middle dot>0-8<middle dot>3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15<middle dot>9 deaths per 100 000 population [95% uncertainty interval 14<middle dot>0-18<middle dot>2]) and White population (14<middle dot>8 deaths per 100 000 [14<middle dot>6-15<middle dot>0]), and was about half as high among the Latino (8<middle dot>7 deaths per 100 000 [8<middle dot>3-9<middle dot>0]), Black (8<middle dot>1 deaths per 100 000 [7<middle dot>9-8<middle dot>4]), and Asian (7<middle dot>5 deaths per 100 000 [7<middle dot>1-7<middle dot>9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin. Interpretation Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research. Funding US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research). Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.