Socioenvironmental factors in fall-related injury

Résumé fourni par la source

Accidental falls remain a significant public health problem as injury rates are increasing despite aggressive prevention efforts. This study hypothesized that prevention programs are ineffective due to a generic focus on the elderly, and an unrecognition of place-related effects involved in the etiology of injurious falls. A social epidemiological framework to fall-related injury assessment was applied as it would address socioenvironmental factors lacking in traditional patient-centered models. Utilizing a state-wide hospital registry, a retrospective, ecological population-based cohort study was conducted to explore how fall-related injuries vary based on the level of urbanization and socioeconomic deprivation. Study objectives were to estimate the incidence of fall-related injury by age, gender, and geographic unit for an entire state over five years, and to assess place-related effects. Descriptive statistical results were similar to those nationally reported, with injury rates highest in younger and older populations. Multivariate regression demonstrated that population size and density had a curvilinear relationship with fall injury, with injury rates higher in less populated towns. Moreover, socioeconomic deprivation had a strongly positive association with fall injury. The combined net effect of its interaction with age, gender, and population size showed a significant increase in injury rates among young males, as well as young and middle-aged adults residing in towns with high socioeconomic deprivation. Conventional risk factors associated with physical development and aging may be stronger determinates for fall-related injury in the youngest and oldest populations whereas socioenvironmental factors may increase injury risks in younger and middle-aged adults through different mechanisms.