Reactive surveillance of deaths involving a fall among the elderly in France, 2015 to March 2023

Abstract In 2022, France launched an elderly anti-fall plan with a goal to reduce fatal falls by 20% within 5 years. In a reactive monitoring approach ensuring comparability over the period, our study aims to develop an algorithm to identify deaths involving a fall using free-text medical causes in death certificates. This will enable proactive surveillance and evaluate plan effectiveness upon completion. We devised an algorithm based on textual search of fall-related expressions in death certificates. Performance metrics were assessed by contrasting algorithm-identified deaths with those flagged by ICD-10 fall-related codes. We compared also temporal dynamics between the algorithms from 2015 to 2021. Analysis was performed by age group, gender and place of death. Additionally, our algorithm enabled estimation of fall-related death trends from 2015 to 2023. The free-text algorithm exhibited robust performance, with a sensitivity and PPV of 95% when compared to deaths coded with an ICD-10 fall-related underlying or associated cause. Temporal trends between both were highly correlated (correlation coefficient=0.99). Instead of the usual 10000 deaths for fall, we revealed about 13000 deaths linked to falls considering both primary and associated causes. Among these, approximately three-quarters were coded as the underlying cause of death in ICD-10 coding. Regarding trends, the results are preliminary and suggested an increase in mortality rates related to falls detected by the algorithm between 2015 and 2022. Our approach distinguishes falls from other competing causes that often relegate them to secondary status in the chain of morbid events leading to death. With free-text medical causes accessible within 3 to 4 months, monitoring deaths involving falls can be done at a detailed geographic level and in a more reactive way. Looking ahead, we must also consider incorporating the impact of epidemics and/or heat waves to accurately evaluate the effectiveness of the anti-fall plan. Key messages • Algorithm using free-text of death certificates identify deaths involving falls. • Our innovative approach isolates falls from other competing causes, elevating their significance in death processes.