Trends and inequities in fall- and musculoskeletal disorder–related mortality among U.S. adults aged 65 years and older, 1999–2023

Background: Musculoskeletal disorders (MSDs) and falls increasingly threaten U.S. older adults. Contemporary trend analyses are essential for targeted prevention. Objective: To assess national and subgroup trends in aggregate mortality attributable to MSDs or falls among U.S. adults aged ≥65 years (1999-2023). Methods: Analyzing CDC WONDER data, deaths with an underlying cause of MSDs or falls were aggregated. We calculated age-adjusted mortality rates (AAMRs) per 100,000 and estimated average annual percent changes (AAPCs) using joinpoint regression, stratified by year, sex, age group, race/ethnicity, state, Census region, and urban-rural classification. Results: From 1999 to 2023, the composite AAMR rose from 51.73 to 98.30 (AAPC = 2.87%). Disaggregated analysis revealed a historic divergence followed by a recent synergistic surge: post-2017, both MSD- and fall-specific mortalities accelerated concurrently (APCs 4.51% and 3.19%). In 2023, the AAMR and AAPC were 111.65 and 2.94% for men, and 88.13 and 2.56% for women, respectively. Non-Hispanic White adults recorded the highest AAMR (110.94). Geographically, the South (AAPC = 3.23%) and non-metropolitan counties (2020 AAMR: 92.17 vs. 85.82) faced the heaviest burdens. State-level AAPCs peaked in Oklahoma (5.70%) and Vermont (5.30%). Conclusions: The macroscopic mortality burden of musculoskeletal decline and falls is worsening. The recent concurrent acceleration in both domains indicates a systemic breakdown in geriatric mobility preservation, highlighting an urgent need for integrated public health interventions targeting high-risk demographics and regions.