Prevalence and Factors Associated With Falls in Individuals Aged 50 Years and Older Living in Urban and Rural Areas in Brazil: A Cross‐Sectional Analysis

BACKGROUND AND PURPOSE: The factors associated with falls may differ from urban to rural areas. However, there is a paucity of studies investigating this topic. To investigate the prevalence and factors associated with falls in individuals aged 50 years and older living in urban and rural areas. METHODS: This cross-sectional study analyzed 9402 participants aged 50 and older from the ELSI-Brasil study baseline in 2015-2016. Of these, 84.7% lived in urban areas. Self-reported falls in the last 12 months were assessed. The association of falls with age, sex, sleep quality, weakness, weight loss > 3 kg, slow gait, exhaustion, postural balance, osteoporosis, and depression was examined. Weighted prevalence estimates were calculated, and associations with falls were assessed using hierarchical Poisson regression models accounting for the complex sampling design and stratified by area of residence. RESULTS: The overall prevalence of falls was 22.4% and was higher among urban than rural residents (22.8% vs. 20.1%). Women had a higher prevalence of falls in both urban (PR: 1.64; 95% CI: 1.48-1.82) and rural areas (PR: 1.26; 95% CI: 1.06-1.49). Compared with individuals aged 50-59 years, the prevalence of falls was higher among those aged 70-79 years (urban PR: 1.25; 95% CI: 1.10-1.43; rural PR: 1.54; 95% CI: 1.12-2.12) and aged ≥ 80 years (urban PR: 1.39; 95% CI: 1.17-1.66; rural PR: 1.65; 95% CI: 1.20-2.27). Slow gait (urban PR: 1.41; 95% CI: 1.22-1.63; rural PR: 1.67; 95% CI: 1.12-2.49) and exhaustion (urban PR: 1.46; 95% CI: 1.29-1.65; rural PR: 1.93; 95% CI: 1.51-2.47) were associated with falls in both areas. Among urban residents, poor sleep quality (PR: 1.32; 95% CI: 1.20-1.44), weight loss more than 3 kg (PR: 1.23; 95% CI: 1.07-1.42), postural balance impairment (PR: 1.28; 95% CI: 1.05-1.56), and depression (PR: 1.45; 95% CI: 1.28-1.64) were also associated with a higher prevalence of falls. However, significant interactions with area of residence were observed only for sex and depression. DISCUSSION: Over 20% of non-institutionalized Brazilians aged 50 years and older had one or more falls in the past 12 months. Female sex, older age, slow gait speed, and exhaustion were associated with falls in individuals aged 50 years or older in urban and rural areas. Poor sleep quality, weight loss > 3 kg, and depression were associated with falls only in individuals aged 50 years and older in urban areas. The association between female sex and falls was stronger among urban than rural residents, whereas the association between depression and falls differed significantly by area of residence and was observed only among urban residents. TRIAL REGISTRATION: The ELSI-Brazil was approved by the Ethics Committee of the Oswaldo Cruz Foundation-Minas Gerais and the process is registered on Plataforma Brasil (CAAE: 34649814.3.0000.5091).