Nonfatal and Fatal Falls Among Adults Aged ≥65 Years

United States, 2020-2021

Ramakrishna Kakara, MPH; Gwen Bergen, PhD; Elizabeth Burns, MPH; Mark Stevens, MA, MSPH

Morbidity and Mortality Weekly Report. 2023;72(35):938-943.

Abstract and Introduction

Abstract

In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.

Introduction

Among adults aged ≥65 years (older adults) in the United States, the leading cause of injury and injury deaths is unintentional falls.* Although the estimated prevalence of nonfatal and fatal falls increases with age, falls are not an inevitable part of aging. Older adult falls can be prevented by addressing modifiable risk factors through effective preventive strategies. Nationally, the medical costs attributed to nonfatal and fatal falls in this age group amounts to approximately $50 billion every year.^[1] Demographic and geographic variation in the distribution of fatal falls has been reported.^[2] This report aims to identify the differences in nonfatal and fatal falls estimates by sex and state.

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Abstract and Introduction
Methods
Results
Discussion
References
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*https://www.cdc.gov/falls/data/index.html

Table 1. Age-adjusted* percentage of adults aged ≥65 years reporting one or more unintentional falls in the past year and age-adjusted unintentional fall-related death ^† rate among adults aged ≥65 years, by demographic characteristics — Behavioral Risk Factor Surveillance System, 2020 and National Vital Statistics System, 2021, United States
Characteristic	No. reporting ≥1 fall^§	Age-adjusted % reporting ≥1 fall (95% CI)	No. of deaths	Age-adjusted fall-related death* (95% CI)
Total	14,058,840	27.6 (27.0–28.2)	38,742	78.0 (77.2–78.8)
Sex
Men	5,825,344	26.1 (25.2–27.0)	18,614	91.4 (90.1–92.7)
Women	8,233,496	28.9 (28.1–29.8)	20,128	68.3 (67.3–69.2)
Age group, yrs
65–74	7,765,341	25.6 (24.9–26.4)	6,409	19.0 (18.6–19.5)
75–84	4,731,620	28.6 (27.5–29.8)	12,136	74.9 (73.6–76.2)
≥85	1,561,879	32.9 (31.0–34.9)	20,197	338.0 (333.3–342.6)
Race and ethnicity^¶
American Indian or Alaska Native	153,540	35.6 (28.9–42.3)	155	57.3 (48.1–66.5)
Asian	146,878	14.5 (9.8–19.2)	1058	43.7 (41.1–46.4)
Black or African American	1,100,915	22.6 (20.5–24.6)	1,572	35.1 (33.3–36.8)
Native Hawaiian or other Pacific Islander	9,373	21.6 (7.6–35.6)	28	47.1 (31.0–68.5)
White	11,244,263	28.8 (28.2–29.5)	33,915	89.4 (88.4–90.3)
Hispanic or Latino	968,611	24.3 (21.0–27.5)	1,875	43.1 (41.1–45.1)
Multiple races/Other race	193,665	26.1 (22.3–29.8)	94	23.6 (19.0–28.9)
Urban/Rural status**
Large central metro	3,451,480	25.8 (24.2–27.4)	9,005	60.4 (59.2–61.7)^††
Large fringe metro	3,379,369	27.2 (26.0–28.4)	9,714	69.9 (68.5–71.3)^††
Medium metro	2,994,019	27.4 (26.3–28.5)	9,362	76.9 (75.4–78.5)^††
Small metro	1,486,869	29.5 (27.9–31.0)	4,084	73.3 (71.0–75.5)^††
Micropolitan (nonmetropolitan)	1,427,693	28.7 (27.5–29.8)	3,878	73.4 (71.1–75.7)^††
Noncore (nonmetropolitan)	1,319,411	31.4 (30.0–32.8)	2,699	67.0 (64.4–69.5)^††

*Percentages and rates were standardized to the 2000 U.S. Census Bureau standard population with age groups 65–74, 75–84, and ≥85 years using the direct method.
^† International Classification of Diseases, Tenth Revision codes W00–W19 were used to identify an unintentional fall as the underlying cause of death.
^§Nationally representative weighted number of adults aged ≥65 years reporting at least one fall in the previous year.
^¶Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.
**Status follows CDC's National Center for Health Statistics 2013 Urban-Rural Classification Scheme for counties. https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf
^††The 2021 death rates by urban-rural continuum were crude rates because age-adjusted rates are currently not available in CDC WONDER. https://wonder.cdc.gov/wonder/help/ucd-expanded.html#Constraints-Rates

Table 2. Age-adjusted* percentage of adults aged ≥65 years reporting one or more unintentional falls in the past year and age-adjusted unintentional fall-related death ^† rate among adults aged ≥65 years, by sex, U.S. Census Bureau region, and state — Behavioral Risk Factor Surveillance System, 2020 and National Vital Statistics System, 2021, United States
Jurisdiction	Age-adjusted % reporting ≥1 fall (95% CI)			Age-adjusted fall-related death rate* (95% CI)
Jurisdiction	Women	Men	Overall	Women	Men	Overall
Overall	28.9 (28.1–29.8)^§	26.1 (25.2–27.0)^§	27.6 (27.0–28.2)	68.3 (67.3–69.2)^§	91.4 (90.1–92.7)^§	78.0 (77.2–78.8)
U.S. Census Bureau Northeast Census Region
Overall	27.1 (25.5–28.6)^¶	25.3 (23.5–27.0)^¶	26.2 (25.0–27.3)^¶	58.0 (56.1–60.0)^§,¶	84.9 (81.9–87.9)^§,¶	68.9 (67.2–70.5)^¶
Connecticut	22.3 (19.3–25.4)^¶	21.3 (17.8–24.9)^¶	21.8 (19.5–24.1)^¶	57.8 (50.1–65.5)^§,¶	96.8 (84.3–109.2)^§	73.5 (66.8–80.3)
Maine	30.0 (27.5–32.5)	29.4 (26.4–32.4)**	29.6 (27.7–31.5)**	129.0 (110.7–147.2)**	124.0 (102.3–145.7)**	128.0 (114.0–142.1)**
Massachusetts	26.8 (23.2–30.4)	25.6 (21.5–29.7)	26.0 (23.3–28.6)	78.9 (72.2–85.5)^§,**	110.1 (100.0–120.1)^§,**	91.0 (85.4–96.6)**
New Hampshire	28.3 (25.4–31.1)	29.5 (25.9–33.0)	28.8 (26.6–31.1)	87.2 (71.6–102.8)^§,**	127.4 (103.9–150.9)^§,**	103.6 (90.3–116.8)**
New Jersey	26.4 (23.3–29.5)	24.5 (21.1–27.9)	25.6 (23.3–27.9)	25.0 (21.7–28.3)^§,¶	40.9 (35.6–46.1)^§,¶	31.5 (28.6–34.4)^¶
New York	26.5 (23.8–29.1)	24.1 (20.9–27.2)	25.3 (23.3–27.3)^¶	42.4 (39.6–45.3)^§,¶	59.8 (55.6–64.0)^§,¶	49.4 (47.0–51.8)^¶
Pennsylvania	28.6 (24.1–33.1)	27.0 (22.0–31.9)	27.9 (24.6–31.3)	74.3 (69.8–78.9)^§,**	118.5 (111.4–125.7)^§,**	92.1 (88.2–96.1)**
Rhode Island	28.0 (24.2–31.8)	23.0 (18.9–27.1)	25.8 (23.0–28.6)	114.1 (94.4–133.9)**	133.2 (107.5–163.2)**	121.5 (105.6–137.4)**
Vermont	33.9 (30.1–37.7)^§,**	27.3 (23.7–30.8)^§	31.0 (28.3–33.6)**	118.6 (93.9–147.8)	139.7 (106.9–179.5)**	129.0 (107.8–150.2)**
U.S. Census Bureau Midwest Census Region
Overall	28.0 (26.8–29.1)	27.5 (26.1–28.9)	27.7 (26.8–28.6)	83.0 (80.7–85.2)^§,**	106.6 (103.5–109.8)^§,**	92.9 (91.1–94.7)**
Illinois	20.8 (16.6–25.0)^¶	18.8 (13.8–23.9)^¶	19.9 (16.7–23.1)^¶	50.8 (46.7–54.9)^§,¶	78.7 (72.3–85.1)^§,¶	62.2 (58.6–65.7)^¶
Indiana	31.9 (29.1–34.8)**	29.5 (26.3–32.6)**	30.8 (28.7–32.9)**	46.7 (41.2–52.3)^§,¶	76.4 (67.5–85.3)^§,¶	58.2 (53.4–63.1)^¶
Iowa	30.8 (28.1–33.6)	29.8 (26.7–32.9)**	30.4 (28.3–32.4)**	97.7 (86.8–108.6)**	106.0 (92.1–119.9)**	102.6 (93.9–111.2)**
Kansas	30.9 (28.5–33.3)	29.0 (26.0–31.9)	29.9 (28.1–31.8)**	88.1 (76.8–99.3)^§,**	119.6 (103.7–135.6)^§,**	101.7 (92.3–111.0)**
Michigan	29.5 (26.6–32.5)	29.7 (26.0–33.4)	29.4 (27.1–31.7)	75.7 (70.1–81.2)^§,**	103.4 (95.4–111.5)^§,**	87.2 (82.6–91.9)**
Minnesota	29.4 (27.1–31.7)	28.6 (26.0–31.2)	29.1 (27.4–30.8)	129.8 (119.9–139.7)^§,**	158.4 (145.1–171.8)^§,**	141.8 (133.9–149.8)**
Missouri	31.5 (28.7–34.4)	31.1 (27.5–34.7)**	31.3 (29.0–33.5)**	68.6 (61.8–75.3)^§	86.3 (76.9–95.7)^§	75.7 (70.2–81.1)
Nebraska	27.7 (25.5–29.9)	27.9 (25.3–30.6)	27.8 (26.1–29.5)	56.1 (45.5–68.6)^§	74.9 (60.0–92.4)^§,¶	63.4 (54.2–72.5)^¶
North Dakota	28.3 (25.0–31.6)^§	23.2 (19.6–26.8)^§	26.0 (23.6–28.4)	82.0 (62.7–105.4)	103.2 (76.6–136.0)	91.7 (74.7–108.6)
Ohio	28.5 (26.0–31.0)	29.0 (26.1–31.9)	28.5 (26.6–30.4)	81.0 (75.7–86.2)^§,**	98.3 (91.0–105.6)^§	88.4 (84.1–92.7)**
South Dakota	31.9 (27.3–36.5)	36.6 (29.9–43.3)**	34.0 (30.0–38.0)**	131.7 (106.9–156.5)**	152.9 (121.6–189.8)**	140.3 (120.5–160.1)**
Wisconsin	27.1 (23.1–31.0)	28.7 (24.0–33.3)	27.5 (24.4–30.5)	168.3 (157.4–179.1)**	184.7 (170.7–198.6)**	176.5 (167.9–185.1)**
U.S. Census Bureau South Census Region
Overall	29.6 (28.3–30.8)^§	25.6 (24.2–27.1)^§	27.8 (26.8–28.7)	67.2 (65.7–68.8)^§	90.6 (88.5–92.8)^§	77.1 (75.8–78.4)
Alabama	29.9 (26.2–33.6)	25.7 (21.5–29.9)	28.1 (25.3–30.8)	26.3 (21.6–31.0)^§,¶	37.3 (30.3–44.2)^§,¶	30.7 (26.8–34.7)^¶
Arkansas	33.6 (30.4–36.8)**	32.9 (28.9–36.8)**	33.1 (30.7–35.6)**	45.7 (37.6–53.7)^¶	53.9 (43.3–64.5)^¶	49.3 (42.8–55.7)^¶
Delaware	28.1 (23.4–32.8)	23.2 (18.3–28.1)	26.0 (22.6–29.4)	43.4 (31.2–58.9)^¶	54.2 (38.0–75.1)^¶	48.2 (38.1–60.2)^¶
District of Columbia	30.0 (25.0–35.1)	29.8 (24.5–35.1)	29.9 (26.1–33.6)	59.9 (40.4–85.5)^§	113.5 (78.1–159.4)^§	80.4 (61.9–102.7)
Florida	27.3 (23.9–30.6)^§	20.8 (17.1–24.6)^§,¶	24.4 (21.9–26.9)^¶	77.6 (74.2–81.1)^§,**	99.1 (94.6–103.6)^§,**	87.3 (84.5–90.1)**
Georgia	27.9 (24.6–31.2)	29.3 (25.6–33.1)	28.4 (25.9–30.8)	48.8 (43.8–53.7)^§,¶	73.1 (65.7–80.6)^§,¶	58.8 (54.6–63.0)^¶
Kentucky	31.3 (26.8–35.8)	30.9 (25.3–36.5)	31.2 (27.7–34.7)**	49.7 (42.7–56.8)^§,¶	76.1 (65.4–86.7)^§,¶	60.6 (54.6–66.6)^¶
Louisiana	30.7 (26.0–35.4)	27.8 (23.1–32.5)	29.4 (26.0–32.8)	44.9 (38.2–51.6)^§,¶	75.9 (65.1–86.7)^§,¶	57.6 (51.7–63.5)^¶
Maryland	26.7 (24.1–29.3)	23.2 (20.6–25.8)^¶	25.1 (23.3–27.0)^¶	72.1 (65.0–79.2)^§	100.5 (90.0–111.1)^§	83.7 (77.7–89.6)
Mississippi	27.8 (25.0–30.6)	25.0 (21.4–28.6)	26.5 (24.3–28.8)	63.4 (53.6–73.3)	73.8 (60.4–87.1)^¶	67.9 (59.9–75.8)^¶
North Carolina	30.7 (26.6–34.8)	26.4 (22.2–30.6)	28.9 (25.9–31.9)	85.3 (79.2–91.3)^§,**	111.5 (102.8–120.1)^§,**	95.9 (90.9–100.9)**
Oklahoma	31.3 (27.8–34.7)	27.5 (23.5–31.4)	29.6 (27.0–32.3)	118.4 (106.7–130.1)^§,**	146.7 (131.0–162.5)^§,**	130.6 (121.2–140.1)**
South Carolina	29.5 (25.4–33.6)	27.6 (22.5–32.7)	28.5 (25.3–31.7)	68.1 (60.5–75.7)^§	92.2 (81.4–103.0)^§	78.1 (71.9–84.4)
Tennessee	35.0 (30.5–39.4)^§,**	26.5 (21.4–31.5)^§	31.2 (27.9–34.5)**	74.2 (67.3–81.2)^§	103.8 (93.6–114.1)^§,**	85.9 (80.1–91.7)**
Texas	30.8 (26.4–35.2)	27.0 (22.3–31.7)	29.0 (25.8–32.3)	57.9 (54.4–61.3)^§,¶	75.1 (70.4–79.8)^§,¶	65.1 (62.3–67.9)^¶
Virginia	28.0 (25.3–30.7)	24.6 (21.4–27.8)	26.4 (24.3–28.5)	64.7 (58.8–70.6)^§	100.1 (91.2–109.1)^§	79.4 (74.4–84.4)
West Virginia	33.1 (29.9–36.3)**	33.1 (29.2–37.0)**	33.1 (30.6–35.6)**	120.3 (104.3–136.3)^§,**	152.1 (130.5–173.6)^§,**	133.7 (120.8–146.6)**
U.S. Census Bureau West Census Region
Overall	30.4 (27.9–32.9)^§	26.1 (23.6–28.7)^§	28.4 (26.6–30.1)	64.3 (62.3–66.3)^§,¶	83.9 (81.3–86.6)^§,¶	72.8 (71.2–74.4)^¶
Alaska	40.3 (33.8–46.8)**	35.6 (29.2–42.0)**	38.0 (33.4–42.6)**	78.3 (51.6–113.9)	81.2 (51.5–121.9)	80.1 (59.6–105.3)
Arizona	27.5 (24.1–30.8)	27.0 (23.5–30.5)	27.3 (24.8–29.7)	83.3 (76.2–90.4)**	88.9 (80.8–97.0)	86.1 (80.7–91.4)**
California	30.6 (25.6–35.7)^§	23.2 (18.0–28.4)^§	27.1 (23.4–30.7)	34.0 (32.0–36.0)^§,¶	55.6 (52.5–58.7)^§,¶	43.1 (41.3–44.8)^¶
Colorado	30.0 (27.2–32.9)	31.2 (28.1–34.2)**	30.5 (28.5–32.6)**	117.1 (106.6–127.6)^§,**	150.0 (135.6–164.4)^§,**	130.7 (122.2–139.2)**
Hawaii	22.9 (19.6–26.2)^¶	19.8 (16.1–23.5)^¶	21.5 (19.0–24.0)^¶	34.8 (26.3–45.2)^§,¶	61.4 (47.9–77.4)^§,¶	45.5 (37.6–53.3)^¶
Idaho	28.2 (24.4–32.0)	25.5 (21.5–29.5)	26.8 (24.1–29.6)	115.4 (97.4–133.4)**	123.0 (102.0–144.0)**	119.7 (106.0–133.5)**
Montana	31.8 (28.6–35.1)	30.0 (26.4–33.5)**	31.0 (28.6–33.4)**	118.3 (96.6–139.9)**	119.4 (95.8–147.1)**	117.8 (101.7–133.9)**
Nevada	29.3 (22.6–36.1)	31.1 (23.8–38.3)	29.9 (24.9–35.0)	63.1 (52.6–73.5)^§	94.2 (80.0–108.3)^§	77.3 (68.7–85.9)
New Mexico	33.7 (30.0–37.3)**	33.1 (28.5–37.7)**	33.4 (30.5–36.3)**	88.0 (74.7–101.3)**	94.7 (78.5–110.9)	90.8 (80.5–101.1)**
Oregon	30.5 (26.6–34.4)	26.8 (22.7–31.0)	29.0 (26.1–31.8)	121.5 (110.3–132.7)**	125.1 (111.7–138.5)**	123.8 (115.2–132.4)**
Utah	31.2 (28.3–34.1)	28.8 (25.8–31.8)	30.0 (27.9–32.1)**	99.6 (84.7–114.4)^§,**	127.4 (108.4–146.4)^§,**	112.1 (100.3–124.0)**
Washington	32.6 (29.7–35.5)**	29.8 (26.8–32.8)**	31.4 (29.3–33.5)**	105.4 (97.2–113.7)^§,**	122.8 (112.2–133.4)^§,**	113.4 (106.9–119.9)**
Wyoming	32.4 (28.8–36.1)	30.1 (25.8–34.4)	31.3 (28.6–34.1)**	62.2 (41.7–89.3)	78.4 (52.1–113.3)	70.2 (53.3–90.7)

*Percentages and rates were standardized to the 2000 U.S. Census Bureau Standard population with age groups 65–74, 75–84, and ≥85 years using the direct method.
^† International Classification of Diseases, Tenth Revision codes W00–W19 were used to identify an unintentional fall as the underlying cause of death.
^§Statistically significant difference between women and men at p<0.05.
^¶Statistically lower than the national estimate at p<0.05.
**Statistically higher than the national estimate at p<0.05.

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Nonfatal and Fatal Falls Among Adults Aged ≥65 Years

United States, 2020-2021

Abstract and Introduction

Abstract

Introduction

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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