The role of dominant handgrip strength in fall occurrence possibility and frequency

Falls are a major cause of morbidity, disability, and healthcare burden among older adults in China, and handgrip strength is widely recognized as a physiological marker of fall risk. Existing studies have largely examined the impact of risk factors on the probability of falling, while overlooking fall frequency, which is critical because repeated falls account for most serious injuries and deaths. This study examines the association between handgrip strength and both fall occurrence and fall frequency using pooled cross-sectional data from the China Health and Retirement Longitudinal Study, estimated with a two-part model and heterogeneity analyses by gender, age, and region. The main contribution lies in jointly quantifying the association between handgrip strength and both fall probability and fall frequency within one framework, addressing the literature’s narrow focus on fall occurrence and limited consideration of heterogeneity. Results indicate that higher handgrip strength is associated with reduced fall probability and fewer falls, particularly among men, adults under 85 years, and residents of eastern provinces. Based on these findings, policymakers should expand community-based strength training, improve access to rehabilitation, and integrate routine handgrip strength screening into primary care, with fiscal resources allocated to specific populations and regions to ensure efficient use.