Trend of fall-related mortality among the elderly

Study of time series of rates of fall-related mortality according to CID-10 from 2008 to 2016. Data from the Mortality Information System on death registers of people ≥ 60 living in Brazil were used. The specific rates of fall-related mortality among the elderly were calculated through the ratio between the number of deaths and the elderly population of that year and region. The populational information was obtained from the 2000 and 2010 censuses. The variation rate and temporal trend were obtained through linear regression (p < 0.05).

Results:

The fall-related deaths among the elderly aged ≥ 60 amounted to 72,234 (31.2%). Falls from the same level were the most frequent (53.8%) and death rates in all ages ranged from 29.7 to 44.7 per 100,000 elders. Fall-related deaths increased with age.

Conclusion:

There was a growing trend of fall-related deaths among elderly in all age groups, an event which is avoidable through the adoption of preventive measures. The high rates and growing trend of fall-related deaths, as well as the aging of the Brazilian population, suggest that public policies for protecting the elderly must be prioritized.

DESCRIPTORS
Aged; Accidental Falls; Death; Time Series Studies; Public Health

ICD-10	2008		2016		Total (2008–2016)		%Variation^a
ICD-10	n	%	n	%	n	%	%Variation^a
Falls on same level – W01/W18	2418	44.8	6476	59.0	38857	53.8	31.7
Unspecified falls – W19	2129	39.5	3079	28.1	23158	32.1	−28.9
Fall on and from stairs and steps – W10	198	3.7	309	2.8	2486	3.4	−24.3
Falls from, out of or through building or structure – W13	211	3.9	300	2.7	2272	3.1	−30.8
Falls from bed – W06	158	2.9	306	2.8	1942	2.7	−3.4
Other falls from one level to another – W17	117	2.2	249	2.3	1573	2.2	4.5
Otherb	161	3.0	250	2.3	1946	2.7	−23.3
Total	5392	100.0	10969	100.0	72234	100.0	–

Variables	2008		2009		2010		2011		2012		2013		2014		2015		2016		Total
Variables	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Total fall-related deaths	5392	–	5671	–	6802	–	7116	–	7844	–	8775	–	9539	–	10126	–	10969	–	72234	–
Age range (years)
60 to 69	1004	18.6	1023	18.0	1203	17.7	1221	17.1	1358	17.3	1482	16.9	1562	16.4	1652	16.3	1801	16.4	12306	17.0
70 to 79	1554	28.8	1576	27.8	1828	26.9	1869	26.3	2020	25.8	2244	25.6	2420	25.4	2583	25.5	2729	24.9	18823	26.1
≥80	2834	52.6	3072	54.2	3771	55.4	4026	56.6	4466	56.9	5049	57.5	5557	58.2	5891	58.2	6439	58.7	41105	56.9
Sex
Male	2688	49.9	2759	48.7	3382	49.7	3505	49.3	3711	47.3	4172	47.5	4476	46.9	4771	47.1	5275	48.1	34739	48.0
Female	2703	50.1	2912	51.3	3420	50.3	3610	50.7	4133	52.7	4603	52.5	5060	53.0	5353	52.9	5693	51.9	37487	51.9
Unreported	1	0.0	0	0.0	0	0.0	1	0.0	0	0.0	0	0.0	3	0.1	2	0.0	1	0.0	8	0.1
Marital status
Without partner	3163	58.7	3488	61.5	4190	61.6	4243	59.6	4657	59.4	5160	58.8	5735	60.1	6110	60.3	6521	59.5	43267	59.9
With partner	1920	35.6	1902	33.5	2273	33.4	2367	33.3	2557	32.6	2885	32.9	3084	32.3	3312	32.7	3637	33.1	23937	33.1
Unreported	309	5.7	281	5.0	339	5.0	506	7.1	630	8.0	730	8.3	720	7.6	704	7.0	811	7.4	5030	7.0
Site of occurrence
Hospital	4601	85.3	4929	86.9	5962	87.7	6273	88.2	6975	88.9	7745	88.3	8457	88.7	8979	88.7	9787	89.2	63708	88.3
Not the hospital	782	14.5	734	12.9	833	12.2	837	11.8	866	11.1	1020	11.6	1078	11.3	1141	11.3	1178	10.8	8469	11.7
Unreported	9	0.2	8	0.2	7	0.1	6	0.0	3	0.0	10	0.1	4	0.0	6	0.0	4	0.0	57	0.0
Region of residency
South	952	17.6	948	16.8	1130	16.7	1284	18.1	1347	17.2	1591	18.1	1784	18.7	1938	19.1	2224	20.3	13198	18.3
Northeast	898	16.6	921	16.2	1076	15.8	1259	17.7	1409	18.0	1488	17.0	1733	18.2	1843	18.2	2112	19.3	12739	17.6
Southeast	2915	54.1	3028	53.4	3722	54.7	3722	52.3	4118	52.5	4566	52.0	4853	50.9	5115	50.5	5192	47.3	37231	51.6
Center-west	462	8.6	568	10.0	633	9.3	579	8.1	678	8.6	818	9.3	853	8.9	857	8.5	1012	9.2	6460	8.9
North	165	3.1	206	3.6	241	3.5	272	3.8	292	3.7	312	3.6	316	3.3	373	3.7	429	3.9	2606	3.6

Age group (years)	Region	Rate per 100,000 citizens									Variation^a(%)
Age group (years)	Region	2008	2009	2010	2011	2012	2013	2014	2015	2016	Variation^a(%)
60 to 69	BR	9.9	9.7	11.0	10.7	11.3	11.8	11.9	12.1	12.7	28.3
70 to 79		27.7	27.3	30.7	30.5	31.9	34.4	35.9	37.0	37.6	35.7
≥80		116.0	120.0	141.0	144.0	153.0	166.0	175.0	178.0	186.0	60.3
All ages		29.7	30.1	34.7	34.9	37.0	39.7	41.5	42.3	44.7	50.5
60 to 69	CW	11.2	10.3	9.8	11.1	12.1	10.8	12.6	10.7	14.8	32.1
70 to 79		31.6	39.4	43.3	30.4	33.8	45.3	43.6	40.7	54.6	72.8
≥80		175.0	207.0	236.0	197.0	213.0	258.0	265.0	260.0	341.0	94.9
All ages		35.3	40.8	45.0	37.8	41.2	49.2	50.7	48.3	63.6	80.2
60 to 69	NE	6.0	6.2	6.6	7.0	7.7	8.7	9.1	8.7	10.8	80.0
70 to 79		16.2	15.8	16.6	20.9	21.4	21.9	23.2	26.0	28.8	77.8
≥80		75.7	75.5	90.6	101.0	113.0	113.0	134.0	137.0	145.0	91.5
All ages		19.1	19.1	21.6	24.6	26.7	27.3	30.9	31.8	35.3	84.8
60 to 69	N	6.5	8.2	9.6	8.2	8.9	9.6	8.3	8.8	9.9	52.3
70 to 79		20.3	17.7	24.3	26.1	24.1	23.2	24.4	26.3	29.4	44.8
≥80		77.6	108.0	107.0	128.0	136.0	139.0	135.0	158.0	167.0	115.2
All ages		18.3	22.0	24.7	26.6	27.3	27.8	26.9	30.3	33.2	81.4
60 to 69	SE	12.1	11.8	13.9	12.9	13.6	13.9	13.2	14.2	13.7	13.2
70 to 79		32.6	31.6	36.7	34.4	36.7	40.1	40.1	41.2	38.7	18.7
≥80		126.0	128.0	151.0	148.0	158.0	168.0	176.0	173.0	172.0	36.1
All ages		34.2	34.1	40.3	38.7	41.0	43.6	44.4	44.9	43.7	27.8
60 to 69	S	10.4	9.6	10.1	10.3	10.9	11.7	13.3	12.6	12.3	18.3
70 to 79		32.6	31.3	33.0	35.4	36.2	36.8	44.0	43.5	43.5	33.4
≥80		149.0	149.0	172.0	189.0	190.0	221.0	215.0	232.0	244.0	63.8
All ages		34.8	34.1	38.1	41.3	42.3	47.2	49.7	51.5	53.2	52.9

Age group (years)	Region	R²	Regression coefficient (β1) (95% CI of β1)	p	Trend
60 to 69	Brazil	0.93	0.35 (0.271–0.438)	<0.001	↑
70 to 79		0.96	1.38 (1.145–1.620)	<0.001	↑
≥80		0.98	9.10 (7.847–10.349)	<0.001	↑
All ages		0.98	1.92 (1.675–2.157)	<0.001	↑
60 to 69	Center-west	0.40	0.35 (–0.130–0.826)	0.129	–
70 to 79		0.44	1.86 (0.141–3.572)	0.038	–
≥80		0.76	15.76 (7.203–24.313)	0.003	↑
All ages		0.72	2.64 (1.032–4.250)	0.006	–
60 to 69	Northeast	0.92	0.56 (0.374–0.739)	<0.001	↑
70 to 79		0.94	1.59 (1.202–1.970)	<0.001	↑
≥80		0.97	9.35 (8.133–10.569)	<0.001	↑
All ages		0.98	2.07 (1.771–2.368)	<0.001	↑
60 to 69	North	0.39	0.24 (–0.045–0.519)	0.088	–
70 to 79		0.63	0.99 (0.390–1.593)	0.006	–
≥80		0.91	9.57 (6.747–12.392)	<0.001	↑
All ages		0.89	1.50 (1.021–1.981)	<0.001	↑
60 to 69	Southeast	0.52	0.22 (0.038–0.401)	0.024	–
70 to 79		0.76	1.09 (0.497–1.692)	0.003	↑
≥80		0.87	6.47 (4.020–8.926)	<0.001	↑
All ages		0.84	1.39 (0.787–1.995)	0.001	↑
60 to 69	South	0.76	0.41 (0.189–0.624)	0.003	↑
70 to 79		0.88	1.73 (1.184–2.268)	<0.001	↑
≥80		0.96	12.50 (10.882–14.117)	<0.001	↑
All ages		0.98	2.58 (2.184–2.978)	<0.001	↑

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Adenicia Custódia Silva e Souza, Av. Universitária, 1440, Área IV, St. Universitário, 74605-010 – Goiânia, GO, Brazil, adeniciafen@gmail.com