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J Gerontol A Biol Sci Med Sci. 2018 Oct 25. doi: 10.1093/gerona/gly250. [Epub ahead of print]

Comparing Estimates of Fall-related Mortality Incidence among Older Adults in the United States.

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Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA.
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
School of Social Work, University of Michigan, Ann Arbor, MI, USA.
Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.



Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally-representative cohort to those from a national vital records database and identified correlates of fall-related mortality.


Cause-of-death data from the National Death Index (NDI; 1999-2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of US older adults (N=20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the CDC vital records data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS study entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths.


The overall incidence rate of fall-related mortality was greater in HRS-NDI data (51.6 deaths per 100,000; 95% CI: 42.04, 63.37) compared to CDC data (42.00 deaths per 100,000; 95% CI: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults age 85 and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality.


Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital records estimates.


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