Global and national burden of falls among individuals aged 55 years and older (1990–2021): analysis of the global burden of disease study 2021

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OBJECTIVE: To comprehensively evaluate the epidemiological burden, temporal trends, socio-demographic inequalities, and long-term forecasting of fall-related injuries in older adults (aged ≥ 55 years) through systematic analysis of the Global Burden of Disease (GBD) 2021 dataset. METHODS: We extracted data on fall-related incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for adults aged ≥ 55 from the GBD database (1990-2021). Temporal trends were assessed using estimated annual percentage changes (EAPCs) and joinpoint regression. Age-period-cohort modeling was applied to disentangle the effects of age, time period, and birth cohort. Socioeconomic inequalities were evaluated using the slope index of inequality and concentration index. Future projections to 2046 were generated via Bayesian Age-Period-Cohort analysis. RESULTS: Between 1990 and 2021, the absolute number of fall-related incidence, deaths, and DALYs among older adults doubled globally. While age-standardized rates remained relatively stable, distinct patterns emerged across Socio-demographic Index (SDI) regions: high SDI regions had the highest incidence and prevalence, whereas low SDI regions experienced higher mortality. Joinpoint regression identified sex-specific acceleration phases, notably 2005-2021 for incidence (APC = 3.747), with women demonstrating higher ASIR but men showing elevated ASPR/ASDR. Significant socioeconomic inequalities were observed and have widened over time. Projections indicate a continued increase in the absolute burden of falls through 2046, despite stable or declining age-standardized rates. CONCLUSIONS: Falls represent a major and growing public health challenge among older adults worldwide, with pronounced disparities across sex and socioeconomic levels. There is an urgent need for targeted prevention strategies and enhanced resource allocation-particularly in low SDI settings-to reduce the health impact of falls in aging populations.

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