Global burden of falls 1990-2021: aging effect, age-stratified risk factors, and projection to 2040 in older adults

BACKGROUND: Based on data from the Global Burden of Disease (GBD) 2021, this study assessed the burden of falls from 1990 to 2021, with a focus on older adults (≥60 years), regional disparities, and projections to 2040. METHODS: Age-standardized rates (ASRs) of incidence, prevalence, mortality, DALYs, YLDs, and YLLs were analyzed, along with estimated annual percentage changes (EAPC) and decomposition analysis to quantify the effects of aging and population growth. Age-specific risk factors were estimated via Population Attributable Fraction, and health disparities were examined using the Slope Index of Inequality and Socio-demographic Index (SDI)-linked concentration index. A Bayesian Age-Period-Cohort model projected burdens to 2040. RESULTS: Although the all-age incidence ASR of falls declined, it increased in older adults from 1990 to 2021 [2021 incidence ASR, 5218.93 (95% UI 4056.57-6569.67) per 100 000; EAPCs, 0.49 (95% CI 0.07-0.91)] and was projected to rise further by 2040. Population aging accounted 59.36% for the increase in fall-related death numbers from 1990 to 2021. Low bone mineral density was a leading risk factor for fall-related mortality and DALYs in older adults. The absolute numbers of all burden measures increased in older adults from 1990 to 2021, and were expected to worsen further by 2040. Health inequalities persisted in older adults: lower-SDI regions had higher mortality despite lower incidence/prevalence, while higher-SDI regions showed the opposite. CONCLUSIONS: The public health challenge posed by falls are substantial in older adults. Enhanced preventive strategies alongside efforts to address socioeconomic disparities are needed.