Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters

Introduction Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. Methods We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. Results We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05–1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16–1.19). The OR for fall-related ED visits on cold days (less than −9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. Conclusion Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Long-Term Trends in Unintentional Fall Mortality in China: A Population-Based Age-Period-Cohort Study

Background: Unintentional falls seriously threaten the life and health of people in China. This study aimed to assess the long-term trends of mortality from unintentional falls in China and to examine the age-, period-, and cohort-specific effects behind them.Methods: This population-based multiyear cross-sectional study of Chinese people aged 0–84 years was a secondary analysis of the mortality data of fall injuries from 1990 to 2019, derived from the Global Burden of Disease Study 2019. Age-standardized mortality rates of unintentional falls by year, sex, and age group were used as the main outcomes and were analyzed within the age-period-cohort framework.Results: Although the crude mortality rates of unintentional falls for men and women showed a significant upward trend, the age-standardized mortality rates for both sexes only increased slightly. The net drift of unintentional fall mortality was 0.13% (95% CI, −0.04 to 0.3%) per year for men and −0.71% (95% CI, −0.96 to −0.46%) per year for women. The local drift values for both sexes increased with age group. Significant age, cohort, and period effects were found behind the mortality trends of the unintentional falls for both sexes in China.Conclusions: Unintentional falls are still a major public health problem that disproportionately threatens the lives of men and women in China. Efforts should be put in place urgently to prevent the growing number of fall-related mortality for men over 40 years old and women over 70 years old. Gains observed in the recent period, relative risks (RRs), and cohort RRs may be related to improved healthcare and better education.

The Predictive Power of State-Level Health Care Utilization for Unintentional Fatal Fall Rates

ObjectiveTo examine the predictive power of state-level care utilization and longitudinal trends in mortality from unintentional falls amongst different demographic and geographic strata.Study DesignNationwide, retrospective cohort study.SettingWeb-based Injury Statistics Query and Reporting System (WISQARS) database.MethodsThe exposure was death from an unintentional fall as determined by the United States Centers for Disease Control. Outcomes included aggregate and trend crude and age adjusted death rates. Health care utilization, reimbursement, and cost metrics were also compared.ResultsOver 2001 to 2018, 465,486 total deaths due to unintentional falls were recorded with crude and age-adjusted rates of 8.42 and 7.76 per 100,000 population. Comparing age-adjusted rates, males had a significantly higher age-adjusted death rate (9.89 vs. 6.17; p < 0.00001), but both male and female annual age-adjusted mortality rates are expected to rise (Male: +0.25 rate/year, R 2 = 0.98; Female: +0.22 rate/year, R 2 = 0.99). There were significant increases in death rates commensurate with increasing age, with the adults aged 85 years or older having the highest aggregate (201.1 per 100,000) and trending death rates (+ 8.75 deaths per 100,000/year, R 2 = 0.99). Machine learning algorithms using health care utilization data were accurate in predicting state-level age-adjusted death rates.ConclusionIn the United States from 2001 through 2018, older adults carried the highest death rate from unintentional falls and this rate is forecasted to accelerate. Machine learning models have high accuracy in predicting state-level age-adjusted mortality rates from health care utilization data.

Deaths and Injuries from Unintentional Falls: An Analysis of Nepal Police Records

Falls are a major cause of unintentional injury-related global mortality and morbidity. The actual mortality and morbidity from falls in Nepal have been overlooked and not systematically studied. This study, therefore, aims to present the national status of fall-related deaths and injuries. The study analyzed the fall incidents recorded by Nepal Police for five fiscal years (17 July 2014 to 16 July 2019). These incident recordings were in the form of narratives, and possible variables were extracted for the analysis. In five years, 4,714 people were injured or died from falls in Nepal. The average age of the fall victim was 35.6 years (SD=19.94); the mean age of the person who died from falls was slightly lower (30.9 years) than the injured person (40.4 years). The analysis showed that the fall cases were remarkably greater for males than females. This study found that Bagmati Province, where the capital city was located has the highest death and injury rates from falls, followed by Gandaki Province and Province 1. The study identified 11 different locations of falls. These findings revealed that Nepal has a considerable burden of fall deaths and injuries. However, the actual burden of fall injuries might be higher due to the under-reporting of the incidents through the Nepal Police data recording system.

Improving Local Service Delivery to Prevent Falls in Community-Dwelling Older Adults: Translating Research to Practice

Unintentional falls are the leading cause of both fatal and nonfatal injuries among Americans 65 years of age and older and place an enormous burden on the health care system. As the population continues to age, preventing falls will be increasingly important for reducing morbidity, mortality, and medical costs. Evidence-based fall prevention interventions for older adults exist, but widespread adoption of these interventions is needed. Local health departments, Area Agencies on Aging, first responders, and health care professionals can all play important roles in implementing fall prevention programs. This article presents a conceptual model for local delivery of fall prevention programs for community-dwelling older adults. This model can serve as a guide for translating existing fall prevention research into practice.

Paediatric injuries due to falls from windows and balconies: an 8-year prospective and retrospective review

Background Unintentional falls from windows and balconies pose a serious health risk to children. Limited Canadian data describing such falls currently exist. This study aimed to describe the frequency, demographic characteristics, injury patterns, and risk factors associated with paediatric falls from windows and balconies. Methods This study employed both prospective data collection and retrospective medical record review. Prospectively, consenting families were enrolled from February 2015 to February 2017; retrospectively, charts from January 2009 to December 2014 were reviewed. Children 0 to 16 years of age, who presented to the Stollery Children’s Hospital (Edmonton, Alberta) emergency department due to a fall from a window or balcony, were included. Results A total of 102 children were included; thirty were enrolled prospectively and 72 retrospectively. Median age was 4.5 years (interquartile range 2.83 to 6.83) with 63.7% (65 of 102) males. About 87.2% (89 of 102) of falls were from windows and 12.8% (13 of 102) from balconies. The median estimated height of fall was 4.1 m (interquartile range 3.04 to 4.73). About 58.4% (59 of 101) had at least one major injury (i.e., concussion, fractured skull, internal injury, fractured limb, severe laceration), 36.6% had minor injuries only (i.e., abrasions, contusions, sprains), and 5.0% had no documented injuries. There were no fatalities. About 30.4% (31 of 102) were admitted, with 48.4% of these children (15 of 31) requiring surgery. Conclusion Most falls from windows and balconies occurred in children under the age of 5 years and were associated with serious morbidity, high admission rates, and need for surgery. Child supervision as well as installation of key safety features in windows may help minimize paediatric fall-related injuries.