Increasing Trend of Fatal Falls in Older Adults in the United States, 1992 to 2005: Coding Practice or Reporting Quality?

OBJECTIVES: To investigate whether changes in death certificate coding and reporting practices explain part or all of the recent increase in the rate of fatal falls in adults aged 65 and older in the United States. DESIGN: Trends in coding and reporting practices of fatal falls were evaluated under mortality coding schemes for International Classification of Diseases (ICD), Ninth Revision (1992-1998) and Tenth Revision (1999-2005). SETTING: United States, 1992 to 2005. PARTICIPANTS: Individuals aged 65 and older with falls listed as the underlying cause of death (UCD) on their death certificates. MEASUREMENTS: The primary outcome was annual fatal falls rates per 100,000 U.S. residents aged 65 and older. Coding practice was assessed through analysis of trends in rates of specific UCD fall ICD e-codes over time. Reporting quality was assessed by examining changes in the location on the death certificate where fall e-codes were reported, in particular, the percentage of fall e-codes recorded in the proper location on the death certificate. RESULTS: Fatal falls rates increased over both time periods: 1992 to 1998 and 1999 to 2005. A single falls e-code was responsible for the increasing trend of fatal falls overall from 1992 to 1998 (E888, other and unspecified fall) and from 1999 to 2005 (W18, other falls on the same level), whereas trends for other falls e-codes remained stable. Reporting quality improved steadily throughout the study period. CONCLUSION: Better reporting quality, not coding practices, contributed to the increasing rate of fatal falls in older adults in the United States from 1992 to 2005.