The association of diabetic retinopathy and visual impairment with falls and falls reporting injuries: Findings from the behavioral risk factor surveillance system

• Visual impairment (VI) and diabetic retinopathy (DR) were associated with falls. • Adults with both VI and DR had the highest likelihood of experiencing any fall. • 45–64 years olds had higher odds of falls reporting injury than adults aged ≥65. • VI and DR were associated with social, economic, and health disparities. • Findings support the need to target adults with DR and VI for fall prevention. To investigate the associations between visual impairment (VI) and diabetic retinopathy (DR) with the prevalence of falls, recurrent falls, and falls reporting injuries (FRIs). Cross-sectional analyses of associations between VI, DR, or both VI and DR with the prevalence of any fall, recurrent falls, and FRIs using data from 65,046 adults (45+ years) who completed the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Diabetes Module. Participants were categorized into four groups: no VI or DR (reference), DR only, VI only, and both VI and DR. Separate multivariable logistic regression models, adjusted for sociodemographics and comorbidities, were used to analyze the association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs. The association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs. Compared to adults with no VI or DR, those with VI reported 1.72 greater odds of experiencing any fall (adjusted odds ratio (aOR)=1.716, p<0.001), 1.82 greater odds of an increasing number of falls (aOR=1.824, p<0.001), and 2.08 greater odds of FRIs (aOR=2.076, p<0.001). Similarly, those with DR only also had substantially greater odds of experiencing any fall (aOR=1.741, p<0.001), an increasing number of falls (aOR = 1.735, p<0.001), and FRIs (aOR=1.658, p=0.004). The interaction effect between VI and DR was not significant. Subjects with both VI and DR experienced 3.80 greater odds of any fall, 2.73 greater odds of increasing falls, and 2.79 greater odds of FRIs, which was greater than those with VI or DR alone or neither condition. Further, subjects aged 45–64 years had significantly higher odds of FRIs than those aged 65+. Using data from 17 states and territories implementing the 2018 BRFSS Diabetes Module, we found that adults with both VI and DR experienced a greater likelihood of falls, recurrent falls, and FRIs than those with neither or either condition. However, the inability to infer temporal or causal relationships from this cross-sectional, self-reported analysis should be considered. These findings underscore the importance for practitioners to communicate fall risks among people with DR and VI and support policies promoting tailored interventions for people experiencing these specific conditions.