The Burden of Falls of People Aged 60-Year-Old and Above in Mainland China, 1990-2019: Findings from the Global Burden of Disease Study 2019

2021 
Background: Falls in older people have become a major public health concern worldwide but a comprehensive assessment of falls burden for older people in mainland China has not been undertaken. This study aims to investigate the falls burden of people aged 60 years and above at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.        Method: Using data from GBD 2019, we described the falls burden of older people by sex and age group in terms of incidence, mortality, and disability-adjusted life year (DALY) rates and evaluated these indicators at the subnational level from 31 provinces. The overall trend of falls burden was investigated across 31 provinces from 1990 to 2019, while the change of falls burden in different sexes, age groups and provinces were compared between 1990 and 2019.   Findings: In 2019, the incidence rate of falls among people aged 60 years and above was 3799·4 new falls per 100 000 (95% uncertainty interval [UI] 3062·4–4645·0), while there were 39.2 deaths (95%UI 21·8–48·80) per 100 000, and 1238·9 DALYs (95%UI 920·5–1553·2) per 100 000 in mainland China. There was no significant difference in the falls burden between males and females. The incidence, mortality and DALY rates for people aged 80 years and above were significantly higher than other age groups. Large variations in incidence and DALY rates were observed across 31 provinces. Although there were no significant changes in the overall falls mortality in all provinces and DALY rates of 23 provinces from 1990 to 2019, there were large increases in the incidence rate in both males (82·9%, 95%UI 67·4%–100·0%) and females (77·0%, 95%UI 63·3%–91·8%) over the last three decades. The increases in the incidence rate varied from 50·0% (95%UI 42·2%–59·5%) for people aged 60–64 years to 123·8% (95%UI 105·4%–141·9%) for people aged 80 years and above. All provinces had significant increases in the incidence rate with Sichuan being the highest (148·5%, 95%UI 125·5%–171·4%) and Jilin the lowest (14·7%, 95%UI 3·6%–26·1%).  Interpretation: Between 1990 and 2019, the incidence rate of falls increased substantially regardless of sex, age group and province, whereas the mortality and DALY rates of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Minor sex disparity in incidence and mortality rates was identified in the older population. The group at the highest risk of falls was males aged 80 years and above. Provincial inequality was found in the incidence and DALY rates of falls. Falls remain as an ongoing health burden for older people in mainland China, and there is an urgent need for introducing system wide, integrated and cost-effective measures to protect and support older people to minimise the risks and combat this growing burden as the population is aging. Funding: Bill & Melinda Gates Foundation. Declaration of Interest: We declare no competing interests.
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