Global, Regional, and National Burden of Falls Among Older Adults Aged 65 Years and Above: Secondary Data Analysis of the Global Burden of Disease Study 2021

Background: Falls are a leading cause of injury, disability, and death among older adults, posing significant public health challenges. However, comprehensive global analyses of fall-related burdens in older populations remain scarce. Objective: This study aimed to explore the patterns and distribution of the global, regional, and national burden of falls among adults aged 65 years and older. Methods: Data from the Global Burden of Disease study 2021 were used to assess the overall, disability, and mortality burden of falls among adults aged 65 years and older. Age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost were calculated to compare burdens across countries. Health inequalities were evaluated via the slope index of inequality and the concentration index. Frontier analysis identified optimal burden levels by sociodemographic index (SDI). Bayesian age-period-cohort models projected trends up to 2050. Results: DALY age-standardized rates showed a U-shaped distribution across SDI regions: lower-SDI countries faced higher mortality burdens, while higher-SDI countries had elevated disability burdens. Despite an increase in absolute overall burden inequality from 1990 to 2021, absolute inequalities in YLDs and years of life lost declined, with DALYs and YLDs exhibiting relatively more balanced distributions. Frontier analysis pinpointed countries with the greatest burden reduction potential. Projections suggest decreasing overall and mortality burdens by 2050 but rising disability burdens. Conclusions: Higher- and lower-SDI countries face distinct fall-related challenges. Reducing cross-national health inequalities and closing gaps between the observed burden and the optimal burden level achievable at a similar SDI level are critical. Despite projected declines in the overall burden (DALYs), the rising disability burden (YLDs) could present evolving challenges, potentially underscoring the importance of proactive preparedness.