Prevalence and Predictors of Falls Among Younger and Older Adult Pilgrims During the Hajj Mass Gathering: An Age-Stratified Cross-Sectional Study

<b>Background/Objectives</b>: Hajj is a physically demanding mass gathering that presents distinct health risks, particularly for older adults and individuals with comorbidities. Falls are a major cause of injury in such environments; however, limited data exist on their prevalence and determinants during Hajj. This study aimed to (1) estimate the prevalence of falls among adult pilgrims during the Hajj pilgrimage in Saudi Arabia and (2) identify key demographic, behavioural/clinical, and musculoskeletal predictors of fall risk, stratified by age group. <b>Methods</b>: A cross-sectional survey was conducted among 1429 adult pilgrims. Data were collected at major pilgrimage sites in Mecca during the Hajj season. Variables included age, sex, body mass index, smoking status, hypertension, diabetes, physical exhaustion, and musculoskeletal pain. Bivariate chi-square tests and multivariable regression analyses were performed. Age-stratified models were developed for younger adults (≤29 years) and older adults (≥50 years) to account for physiological differences. <b>Results</b>: The overall fall prevalence was 13.6%, with significantly higher rates among older adults (21%) than younger adults (10.5%). In the full sample, independent predictors of falls included older age, obesity, hypertension, diabetes, physical exhaustion, and musculoskeletal pain in the upper arm, elbow, and hip/pelvis. In age-specific models, obesity, physical exhaustion, and upper arm pain predicted falls among younger adults, while obesity, hypertension, physical exhaustion, and hip/pelvis pain were significant among older adults. <b>Conclusions</b>: Falls during Hajj result from a multifactorial interplay of age, comorbidities, fatigue, and site-specific musculoskeletal pain. These findings support the development of targeted, age-specific fall prevention strategies in mass gathering contexts.