Xiaojie Ma^1,a，Shanshan Liu^2,b，Gaohua Wang^3,c*，Lili Zhang^4,d*,Ruihan Wu⁵,Dou Fu⁶,Tian Li⁷,Jiaojiao Wu⁸,Xiangying Shen⁹,Zelin Guo¹⁰

¹Department of Geriatrics, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei, China

²Department of General Practice, Renmin Hospital of Wuhan University,Wuhan 430060,Hubei, China

³Department of Psychiatry, Renmin Hospital of Wuhan University, Institute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei ,China

⁴Cadre Health Department,Renmin Hospital of Wuhan University, Wuhan 430060, Hubei ,China

⁵Nursing Department，Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

⁶Department of General Practice, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

⁷Department of Coronary Artery Disease III, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

⁸Department of Geriatrics, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

⁹Department of Geriatrics, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

¹⁰Department of Urology，Renmin Hospital of Wuhan University,Wuhan 430060, Hubei ,China

^aEmail：675483629@qq.com

^bEmail：1911238766@qq.com

^cEmail：wgh6402@whu.edu.cn

^d   Email：zhanglili_11zll@163.com

Co-first authors：Xiaojie Ma^1,a，Shanshan Liu^2,b
Co-corresponding author：Gaohua Wang^3,c*，Lili Zhang^4,d*

Abstract

Objective
This study analyzes and compares the temporal trends and projections of the fall burden in China and globally from 1990 to 2021. It focuses on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) across eight age groups and both genders.

Methods
Data from the Global Burden of Disease (GBD) study were used to assess age-standardized rates (ASRs) for falls-related outcomes, including incidence, prevalence, mortality, and DALYs. The average annual percent change (AAPC) was calculated to quantify temporal trends. An Age-Period-Cohort (APC) analysis was conducted to explore the effects of aging, period, and birth cohort. Projections for 2021–2036 were estimated using Bayesian Age-Period-Cohort (BAPC) models, with results stratified by gender and age group.

Results
From 1990 to 2021, China’s age-standardized incidence (ASIR) and prevalence rates (ASPR) for falls increased significantly (AAPC: 0.96%, 95% UI: 0.63–1.30, P<0.0001; AAPC: 0.67%, 95% UI: 0.35–0.99, P<0.0001). Conversely, mortality (ASMR) and DALY rates declined (AAPC: -0.47%, 95% UI: -0.67 to -0.26, P<0.0001; AAPC: -0.52%, 95% UI: -0.62 to -0.42, P<0.0001). Global trends showed more gradual changes, with slight decreases in ASIR (AAPC: -0.32%, P<0.0001) and ASPR (AAPC: -0.37%, P<0.0001). Projections for 2021–2036 suggest continued increases in incidence and prevalence, particularly in China, while global mortality and DALYs are expected to stabilize or decline slightly. Gender disparities persist, with males experiencing higher mortality and DALYs.

Conclusions
The burden of falls among older adults is increasing both globally and in China, with notable regional and gender disparities. These findings underscore the need for targeted interventions to address the rising prevalence and mitigate associated health outcomes.

Keywords
Global Burden of Disease, Falls, Elderly, Age-Period-Cohort Analysis, Projections, Bayesian Age-Period-Cohort Model

1.Introduction

The global aging population is growing rapidly, and by 2050, individuals aged 60 and older are expected to constitute over 22% of the world’s total population [1]. This demographic shift presents significant public health challenges, as older adults are more vulnerable to a range of health issues, including falls. Falls among older adults are not only common but also lead to severe injuries and higher mortality, making them one of the leading causes of morbidity and disability in this age group [2]. Research shows that more than 30% of older adults experience falls annually, a prevalence that is expected to rise as the global population continues to age, placing greater pressure on healthcare systems worldwide [1].

Falls in older adults are associated with severe health outcomes, such as fractures, head injuries, and long-term disabilities [3]. The most common fall-related injuries are hip and vertebral fractures, both of which can be debilitating and are linked to increased mortality rates [4]. Specifically, hip fractures carry a 20%-30% mortality rate within the first year, and many survivors face long-term reductions in mobility and independence [4]. The physical consequences of falls often result in prolonged hospital stays, rehabilitation, and long-term care requirements. Beyond physical injuries, falls also have substantial psychological effects, including depression, anxiety, and a heightened fear of falling, which further impair quality of life [3]. As a result, the overall burden of falls is not only measured in healthcare costs but also in the significant impact on the elderly’s quality of life and the psychological toll on both individuals and their caregivers.

The Global Burden of Disease (GBD) database provides global data on diseases, injuries, and risk factors using metrics such as disability-adjusted life years (DALYs) and age-standardized mortality rates. This database aids in projecting future health burdens and guiding public health policies [5]. While the GBD database offers extensive data on fall-related outcomes, much of the existing research using this database is limited in scope, often focusing on specific regions or individual aspects of falls-related health outcomes. For example, studies in countries like Saudi Arabia and Mexico have examined the rising incidence of falls-related disability and premature mortality among older adults [6, 7]. However, these studies typically do not offer a global perspective on trends in fall-related morbidity and mortality. Other studies have categorized falls under broader injury groups, such as unintentional injuries, without assessing the specific burden attributable to falls [8, 9]. Additionally, while research on specific factors like low bone density [10] has contributed to understanding the burden of falls, few studies have examined these factors comprehensively or analyzed fall burden from a broader perspective.

Moreover, although studies by Wang (2024) and Xie (2024) have provided valuable insights into fall trends in specific regions, especially in China and BRICS countries, there is a lack of comparative research that spans regions and provides projections for future trends [10, 11]. This gap limits our understanding of how falls will impact health systems both globally and regionally in the coming decades.

This study seeks to fill this gap by offering a comprehensive analysis of the fall burden among adults aged 60 and above, comparing trends between China and the global population. Using the latest GBD data, this research examines trends in fall-related incidence, prevalence, mortality, and DALYs from 1990 to 2021, while also projecting the future burden of falls through 2036. The study incorporates age-standardized rates and sex-specific data to provide a more nuanced understanding of the fall burden, highlighting differences between China and the global population. By comparing fall-related health outcomes across regions, this study contributes to the growing body of literature on falls and aging, offering valuable insights into how these trends will evolve over the next 15 years. These findings can inform public health policies and intervention strategies aimed at mitigating the impact of falls on older adults.

2.Methods

2.1 Overview

This study investigates the temporal trends and projections of falls-related burdens among adults aged 60 and above, comparing data from China and the global population from 1990 to 2021. Data from the Global Burden of Disease (GBD) Study 2021 were used to analyze falls-related outcomes, including incidence, prevalence, mortality, and DALYs. Key statistical methods, such as Joinpoint regression [12], Age-Period-Cohort (APC) model analysis [13], and Bayesian modeling [14], were employed to assess trends and forecast future burdens through 2036.

2.2 Data Sources

Data were sourced from the GBD 2021 database, which provides age-standardized estimates for falls-related outcomes, including incidence, prevalence, mortality, and DALYs from 1990 to 2021. Data specific to China and the global population were extracted for analysis, with a focus on falls-related health metrics across eight age groups (60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94, and 95+ years), disaggregated by gender. The analysis aimed to examine the temporal trends of these outcomes and compare the fall burden between China and the global population.

2.3 Distribution and Trends of Disease Burdens

The study analyzed the incidence, prevalence, mortality, and DALYs associated with falls in individuals aged 60 and above, comparing data from China and the global population. Age-standardized rates (ASRs) were used to control for population structure differences, allowing for valid regional comparisons [15]. Temporal trends from 1990 to 2021 were assessed to investigate changes in the burden of falls, with a particular focus on trends in incidence and prevalence among older age groups.

2.4 Joinpoint Regression Analysis

Joinpoint regression analysis was performed using the Joinpoint Regression Program [16] to identify shifts in the trends of falls-related outcomes and to understand the temporal variations in falls-related health burdens. The Average Annual Percent Change (AAPC) was calculated to quantify the annual rate of change in incidence, prevalence, mortality, and DALYs from 1990 to 2021.

2.5 Age-Period-Cohort (APC) Model Analysis

The APC model was employed to disentangle temporal trends in falls-related outcomes by isolating the effects of age-related changes, period-specific influences, and birth cohort-specific exposures [13]. This model was used to assess the influence of these factors on the burden of falls across different populations, with particular attention to specific age groups. Trends in fall incidence, prevalence, mortality, and DALYs for each cohort were analyzed. Using R software [17] and the apc package [11], relative risks were estimated for each factor, allowing for a detailed exploration of trends across different age cohorts.

2.6 Prediction Analysis

Prediction analysis was conducted to estimate the future burden of falls from 2021 to 2036. Using a Bayesian predictive model [14], projections for fall incidence, prevalence, mortality, and DALYs were generated by incorporating historical trend data and demographic projections. Separate projections were made for China and the global population to offer insights into the potential trajectory of falls-related health outcomes in aging populations. Results were presented with 95% credible intervals to account for uncertainty in the predictions.

2.7 Statistical Software and Statistical Significance

Analyses were performed using R software (version 4.4.2) [17] and Joinpoint Regression Program (version 5.1.0.0) [16]. Statistical significance was determined at p < 0.05, with uncertain intervals (95% UI) and credible intervals (95%) reported for all estimates.

2.8 Reporting Standards

This study adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) to ensure transparency in data sources, analytical methods, and model assumptions [18].

2.9 Ethical Approval

This study used publicly available, de-identified data from the Global Burden of Disease (GBD) 2021 database and national surveillance systems, which do not require individual consent. Data usage was in accordance with ethical guidelines for secondary data analysis.

3.Results
3.1 Description of the burden of falls in China and worldwide

3.1.1 Incidence of Falls in China and Worldwide

In China, the number of fall cases increased from 24,504,927 (95% UI: 20,896,346–28,950,659) in 1990 to 39,767,672 (95% UI: 35,757,319–44,260,733) in 2021, reflecting a cumulative increase of 62.34%. Globally, the incidence rose from 139,198,203 cases (95% UI: 118,654,345–163,876,782) in 1990 to 206,172,358 cases (95% UI: 181,944,297–231,227,989) in 2021, a cumulative increase of 48.07%. The age-standardized incidence rate (ASIR) in China increased from 2,115.57 (95% UI: 1,798.84–2,459.92) per 100,000 population in 1990 to 2,748.04 (95% UI: 2,469.75–3,032.59) per 100,000 in 2021. In contrast, the global ASIR slightly decreased from 2,327.89 (95% UI: 2,006.24–2,700.45) per 100,000 in 1990 to 2,217.46 (95% UI: 1,908.67–2,552.61) per 100,000 in 2021. Meanwhile, the average annual percent change (AAPC) for the incidence rate in China increased by 0.96% (95% CI: 0.63–1.30, p < 0.0001) from 1990 to 2021, while it decreased globally by 0.32% (95% CI: –0.42 to –0.23, p < 0.0001) (Table 1).

3.1.2 Prevalence of Falls in China and Worldwide

The number of fall cases in China increased from 66,892,214 (95% UI: 57,762,953–78,213,684) in 1990 to 111,705,688 (95% UI: 96,477,815–128,904,567) in 2021, a cumulative increase of 67.01%. Globally, the prevalence rose from 378,926,753 cases (95% UI: 327,162,891–438,994,728) in 1990 to 635,895,474 cases (95% UI: 548,323,098–724,360,209) in 2021, reflecting a cumulative increase of 67.86%. The age-standardized prevalence rate (ASPR) in China increased from 5,749.45 (95% UI: 4,985.23–6,556.37) per 100,000 population in 1990 to 6,116.41 (95% UI: 5,285.94–7,020.31) per 100,000 in 2021. Conversely, the global ASPR decreased slightly from 6,070.53 (95% UI: 5,366.45–6,973.44) per 100,000 in 1990 to 5,842.33 (95% UI: 5,111.89–6,727.80) per 100,000 in 2021. The AAPC for prevalence in China increased by 0.67% (95% CI: 0.35–0.99, p < 0.0001), while it decreased globally by 0.37% (95% CI: –0.48 to –0.27, p < 0.0001) (Table 1).

3.1.3 Mortality of Falls in China and Worldwide

Globally, falls caused 586,435 (95% UI: 475,382–706,870) deaths in 1990, increasing to 802,803 (95% UI: 666,571–947,647) in 2021, a 36.93% increase. In China, deaths from falls increased from 73,322 (95% UI: 58,143–91,483) in 1990 to 141,657 (95% UI: 113,478–171,396) in 2021, representing a 93.19% increase. The age-standardized mortality rate (ASMR) in China decreased from 6.51 (95% UI: 5.17–8.12) per 100,000 in 1990 to 4.84 (95% UI: 3.87–5.87) per 100,000 in 2021. Similarly, the global ASMR declined from 9.80 (95% UI: 8.25–11.66) per 100,000 in 1990 to 6.78 (95% UI: 5.63–7.99) per 100,000 in 2021. The AAPC for mortality in China decreased significantly by 0.47% (95% CI: –0.67 to –0.26, p < 0.0001), while globally it decreased by 0.26% (95% CI: –0.45 to –0.06, p = 0.0091) (Table 1).

3.1.4 DALYs of Falls in China and Worldwide

Global disability-adjusted life years (DALYs) due to falls increased from 50,198,723 (95% UI: 40,912,234–60,893,994) in 1990 to 73,987,532 (95% UI: 60,123,987–88,409,873) in 2021, a cumulative increase of 47.40%. In China, DALYs increased from 4,300,122 (95% UI: 3,489,120–5,280,896) in 1990 to 8,301,289 (95% UI: 6,859,813–9,951,894) in 2021, a 93.01% increase. The age-standardized DALY rate (ASDR) in China decreased from 380.19 (95% UI: 308.55–466.75) per 100,000 in 1990 to 283.65 (95% UI: 234.07–340.62) per 100,000 in 2021. Globally, the ASDR decreased from 794.25 (95% UI: 648.72–963.63) per 100,000 in 1990 to 531.26 (95% UI: 433.96–634.87) per 100,000 in 2021. The AAPC for DALYs in China decreased significantly by 0.52% (95% CI: –0.62 to –0.42, p < 0.0001), while globally it declined by 0.61% (95% CI: –0.68 to –0.54, p < 0.0001) (Table 1).

3.2 Joinpoint Regression Analysis of the Burden of Falls in China and Worldwide

The Joinpoint regression analysis of the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and disability-adjusted life years (DALYs) for falls in China and globally from 1990 to 2021 is shown in Figure 1. In China, both the ASIR and ASPR demonstrated significant upward trends, with a marked increase after 2010, reflecting the rising burden of falls among older populations. In contrast, the ASMR and age-standardized death rate (ASDR) showed consistent declines, indicating progress in reducing fatal and disabling outcomes of falls. Globally, the ASIR and ASPR exhibited slight declines, with modest decreases observed after 2000. Similarly, the ASMR and ASDR showed steady reductions throughout the study period. These trends highlight the contrasting dynamics between non-fatal and fatal fall outcomes in China and worldwide, emphasizing the effectiveness of targeted interventions and the challenges posed by an aging population.

Figure 1 Joint regression analysis of age standardized incidence rate (ASIR), age standardized prevalence rate (ASPR), age standardized mortality rate (ASMR) and disability adjusted life years (DALYs) of falls in China and the world from 1990 to 2021

3.3 Trends in the Burden of Falls in China and Worldwide

The trends in the burden of falls in China and worldwide from 1990 to 2021 are illustrated in Figure 2. In China, the ASDR showed a significant overall decline, decreasing from 380.19 per 100,000 in 1990 to 283.65 per 100,000 in 2021, with a slower pace of decline after 2010. In contrast, the global ASDR decreased gradually from 794.25 per 100,000 in 1990 to 531.26 per 100,000 in 2021, reflecting a consistent decline across all study years. Meanwhile, the ASPR for falls in China increased, particularly after 2010, rising from 5,749.45 per 100,000 in 1990 to 6,116.41 per 100,000 in 2021. Globally, the ASPR showed a modest decline, falling from 6,070.53 per 100,000 in 1990 to 5,842.33 per 100,000 in 2021, indicating divergent trends between China and the global population.

Figure 2  Trends in the Burden of Falls in China and Worldwide from 1990 to 2021

3.4 Burden of Falls in Different Age Groups in China and Globally

In China, the burden of falls has increased over time, with significant age-related disparities in incidence, prevalence, mortality, and DALYs. In 2021, the crude incidence rate (CIR) for falls in the 85–89 age group was 9,650 per 100,000, up from 7,320 per 100,000 in 1990 (Figure 3A, 3E). This upward trend in incidence was observed across all age groups, with China consistently showing higher rates compared to global data, where incidence rates remained lower. Similarly, prevalence rates in China followed an age-related pattern, peaking in the 85–89 age group, which saw an increase from 8,400 per 100,000 in 1990 to 10,200 per 100,000 in 2021 (Figure 3B, 3F). Globally, prevalence rates were lower but showed a similar trend, indicating a greater fall burden in China. Mortality rates rose with age, with the crude mortality rate (CMR) for the 95+ age group declining from 560 per 100,000 in 1990 to 420 per 100,000 in 2021 (Figure 3C, 3G), reflecting the effectiveness of healthcare and fall prevention strategies. Globally, mortality rates were lower across all age groups.

In terms of DALYs, which capture both fatal and non-fatal outcomes, the rate peaked in the 85–89 age group in China, declining from 1,650 per 100,000 in 1990 to 1,230 per 100,000 in 2021 (Figure 3D, 3H). Globally, DALY rates followed a similar declining trend but were consistently lower than those in China. Gender disparities were evident, with Chinese females experiencing higher incidence and prevalence rates, while males had higher mortality and DALY rates, reflecting their greater vulnerability to fatal falls (Figures 3I–3P). Globally, gender differences were less pronounced. These findings highlight the increasing burden of falls in China, particularly among older adults, underscoring the need for targeted interventions.

Figure 3 The burden of falls has significant age differences in incidence rate, morbidity, mortality and disability adjusted life years over time

3.5 Gender Disparities in the Burden of Falls in Different Age Groups in China and Globally

In China, gender disparities in the burden of falls are evident across incidence, prevalence, mortality, and DALYs. In 2021, females aged 85–89 had a crude incidence rate (CIR) of 9,750 per 100,000, compared to 8,980 per 100,000 for males (Figure 4A,4E), indicating a higher fall risk among elderly women. This gender gap in incidence was more pronounced in China than globally, where incidence rates were more balanced between males and females (Figure 4I). In terms of prevalence, females consistently had higher rates across all age groups in China. For example, in 2021, the prevalence for females aged 80–84 was 10,500 per 100,000, compared to 9,800 per 100,000 for males (Figure 4B, 4F). Globally, prevalence rates followed a similar gender-specific pattern, though at lower levels (Figure4J).

Regarding mortality, Chinese males exhibited higher crude mortality rates (CMR) than females, particularly in older age groups. In 2021, males aged 85+ had a CMR of 520 per 100,000, compared to 460 per 100,000 for females (Figure 4C, 4G), suggesting a higher mortality burden among elderly men. DALYs, which account for both fatal and non-fatal outcomes, were also higher in males. In 2021, the DALY rate for males aged 85–89 was 1,480 per 100,000, compared to 1,230 per 100,000 for females (Figure4D, 4H). Globally, similar trends were observed, though gender differences in mortality were less pronounced (Figures 4K, 4L). These findings underscore the gender disparities in the fall burden, with females in China experiencing higher rates of non-fatal outcomes, while males bear a heavier burden in terms of mortality and DALYs.

Figure 4 Trends of gender differences in fall burden in incidence rate, morbidity, mortality and disability adjusted life years

3.6 Age-Period-Cohort (APC) Analysis of Falls Burden in China and Globally

The Age-Period-Cohort (APC) analysis from 1990 to 2021 reveals significant trends in the burden of falls across incidence, prevalence, mortality, and DALYs in China and globally. In China, falls incidence showed a sharp annual increase with a net drift of 1.996% (95% UI: 1.449–2.545) (Figure 5A), while global incidence rose more slowly, with a net drift of 0.436% (95% UI: 0.391–0.481) (Figure 5E). Similarly, prevalence in China increased annually by 0.961% (95% UI: 0.858–1.064) (Figure 5B), whereas global prevalence slightly decreased with a net drift of –0.063% (95% UI: –0.118 to –0.009) (Figure 5F). Mortality rates declined in both regions, with a more pronounced reduction in China (–0.47% per year, 95% UI: –0.62 to –0.32) (Figure 5C) compared to a slower global decline (–0.255% per year, 95% UI: –0.45 to –0.06) (Figure 5G). DALY rates also fell more steeply in China (–0.30% per year, 95% UI: –0.52 to –0.09) (Figure 5D) than globally (–0.255% per year, 95% UI: –0.45 to –0.06) (Figure 5H). These trends indicate that while mortality and DALYs are decreasing, the incidence and prevalence of falls are rising much faster in China than globally.

Figure 5 Major trends in fall incidence, prevalence, mortality, and disability adjusted life years in China and globally

Age-specific APC analysis further highlights the disproportionate falls burden in China’s aging population. By 2021, incidence rates for individuals aged 85+ in China exceeded 2,500 per 100,000, a significant increase from 1990 levels (Figure 6A), accompanied by a notable rise in prevalence (Figure 6B). Cohort effects show that recent birth cohorts in China face a higher burden of falls than older generations (Figure 6C). Globally, the increase in falls burden among older populations is less pronounced, with substantially lower rates for the 85+ age group compared to China (Figures 6E–H). These findings emphasize the need for targeted interventions for China’s rapidly aging population, where the falls burden is rising much faster than globally.

Figure 6 further highlights the disproportionate burden of declining aging population in China through APC analysis targeting specific age groups

3.7 Comparative projections of falls burden by sex in China and globally

Projections for the burden of falls among adults aged 60 and above, stratified by sex, reveal significant differences between China and the global population, as well as notable gender-specific trends. Bayesian Age-Period-Cohort (BAPC) model analysis suggests that incidence and prevalence rates for falls will continue to rise through 2036 in both China and globally, with global rates consistently higher (Figures 7A–H, I–P). The increase in incidence and prevalence is particularly pronounced among males in China, reflecting significant gender disparities. In contrast, global projections suggest more moderate growth, with relatively smaller sex differences. Mortality rates in China are expected to remain stable before 2020, followed by a slight decline, particularly among females. Globally, mortality rates exhibit a gradual downward trend, with females showing more substantial reductions (Figures 7C, G, K, O). These trends likely reflect advancements in healthcare and improved fall prevention measures over recent years.

Projections for DALYs further highlight differences between China and global trends. In China, DALY rates are expected to increase modestly, particularly among males, whereas global rates are anticipated to stabilize or slightly decline (Figures 7D, H, L, P). Gender disparities in DALY burden are more pronounced in China, where males are projected to bear a significantly higher burden than females. Globally, sex differences are less marked, with females occasionally exhibiting a slightly higher burden in certain age groups. The widening credible intervals for these projections, especially after 2020, indicate increasing uncertainty (Figure 7). Collectively, these findings suggest a substantial predicted increase in the falls burden in China, particularly in terms of incidence and prevalence, while global trends indicate stabilization or improvement in mortality and DALY rates. These results underscore the need for tailored, evidence-based strategies to address the growing burden of falls, particularly in aging populations.

Figure 7 Predicts the burden of falls among adults aged 60 and above, stratified by gender, revealing significant differences between the Chinese and global populations, as well as clear trends in gender differences

3. Discussion

This study utilizes advanced statistical techniques to examine temporal trends and projections of falls-related health burdens among adults aged 60 and older, with a comparative analysis between China and the global population. Data from the Global Burden of Disease (GBD) 2021 database were used to analyze key metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. The methodology incorporated Joinpoint regression to detect trend shifts, Age-Period-Cohort (APC) modeling to explore demographic and temporal influences, and Bayesian predictive modeling to forecast falls-related outcomes through 2036. The study addresses crucial issues such as the increasing burden of falls among older adults, the differences in falls-related health metrics between China and global populations, and the demographic and temporal factors influencing these trends. By utilizing age-standardized rates (ASRs), the research ensures valid comparisons across regions and populations, providing a comprehensive understanding of the growing impact of falls, particularly in aging societies.

The findings indicate a significant increase in the incidence, prevalence, and DALYs associated with falls, particularly among the oldest age groups. These trends underscore the growing public health challenges posed by falls, with projections suggesting further increases in falls-related burdens by 2036. Notably, the comparative analysis reveals that, while falls are a major global health issue, China faces unique challenges due to its rapidly aging population and demographic transitions. These results provide a foundation for developing targeted prevention and intervention strategies tailored to specific population needs.

The mechanisms driving these trends are multifactorial, involving biological, social, and environmental factors. Biologically, the aging process contributes to the deterioration of musculoskeletal function, balance, and cognitive capacity, thereby increasing the risk of falls. These declines are exacerbated by chronic conditions such as osteoporosis, arthritis, and cardiovascular diseases, which are common among older adults[19, 20]. Additionally, gender differences in bone density, muscle mass, and lifestyle factors contribute to variations in falls-related outcomes across demographic groups[21]. Social and environmental factors, including urbanization and sedentary lifestyles, also play a significant role. In regions like China, the transition from rural to urban living has created challenges, such as inadequate infrastructure adaptation for aging populations[22]. Globally, disparities in healthcare access, fall prevention programs, and rehabilitation services exacerbate the burden of falls, particularly in resource-limited settings[6]. The interplay between demographic shifts and healthcare system capacity further underpins the observed differences in trends between China and global patterns. China’s rapidly aging population and increasing life expectancy have intensified the demand for geriatric care and fall prevention interventions. However, the uneven distribution of healthcare resources and limited integration of fall prevention into primary care contribute to the rising falls-related burden[23, 24].

Moreover, cultural factors may influence the reporting and management of falls. In some regions, stigma surrounding physical frailty may discourage older adults from seeking timely medical attention or engaging in preventive programs[11]. These sociocultural dynamics highlight the importance of culturally tailored interventions to address barriers to fall prevention and care.

In summary, the findings of this study underscore the complex interaction of biological, social, and systemic factors that contribute to falls-related health burdens. Addressing these challenges requires a multifaceted approach that integrates individualized care, community-based interventions, and policy reforms. Enhanced focus on interdisciplinary research and culturally sensitive strategies will be crucial for mitigating the increasing trends in falls-related outcomes.

The findings of this study demonstrate both consistencies and deviations when compared to prior research on falls-related health burdens. Globally, the upward trends in fall incidence, prevalence, mortality, and DALYs observed in this study align with established literature, reinforcing the public health challenges posed by falls among older adults[1, 25]. However, the study’s focus on the Chinese context reveals specific differences, particularly the accelerated growth in falls-related burdens compared to global averages[20, 24]. Notable disparities also emerge in age-specific and gender-specific trends. Previous studies have found higher falls-related mortality and DALYs among women, largely due to longer life expectancy and higher rates of osteoporosis[22]. In contrast, this study reveals a steeper increase in falls-related mortality among Chinese men, potentially linked to occupational exposures, lower engagement in health-seeking behaviors, and delayed diagnoses of chronic conditions[9]. These findings underscore the importance of developing gender-sensitive fall prevention strategies that address unique risk profiles.

This study distinguishes itself from previous work through its predictive modeling, extending trend analyses to 2036. While earlier research primarily focused on retrospective data trends, this study employs Bayesian modeling to offer a forward-looking perspective, emphasizing the need for urgent preventive measures, particularly in rapidly aging populations. Differences in healthcare infrastructure and resource allocation also clarify disparities between this study and previous research. Unlike regions with well-established fall prevention programs, such as North America and Europe[1, 23], fall prevention in China remains underdeveloped, with limited integration of preventive strategies into primary care and a lack of comprehensive rehabilitation programs. Furthermore, rapid urbanization in China has outpaced the development of age-friendly infrastructure, increasing fall risks among older adults transitioning from rural to urban settings[22]. Cultural stigma surrounding physical frailty may also prevent older individuals from reporting falls or participating in preventive interventions, exacerbating the disparity in falls-related outcomes[20].

Methodologically, the use of Joinpoint regression and Age-Period-Cohort (APC) modeling in this study offers detailed insights into temporal and cohort-specific trends, revealing nuanced patterns that may have been overlooked in traditional studies. The age-stratified analyses in this study also highlight shifts in risk profiles in line with demographic transitions, providing a more comprehensive understanding of the dynamics underlying falls-related health burdens[11].

In conclusion, this study confirms global trends in falls-related burdens while highlighting important regional and demographic disparities. The findings emphasize the need for localized, context-specific strategies to address the multifaceted factors influencing falls. Future efforts should prioritize interdisciplinary approaches and evidence-based interventions that address the distinct challenges identified in this analysis.

The findings have significant public health implications, particularly for aging populations in China and globally. The observed upward trends in falls-related burdens—incidence, prevalence, mortality, and DALYs—underscore the urgent need for targeted interventions. The disproportionate burden on older age groups suggests that prevention strategies must prioritize these vulnerable populations. China’s rapidly aging population and demographic transitions necessitate proactive, evidence-based policies. An interdisciplinary approach that integrates community-based interventions, healthcare infrastructure, and ongoing research is crucial for refining predictive models, improving fall prevention, and enhancing care outcomes.

This study offers both theoretical and practical insights into mitigating falls-related burdens among older adults. Theoretically, it provides an understanding of temporal trends and demographic disparities, shedding light on China’s unique epidemiological patterns[23, 25]. Practically, it emphasizes the importance of DALYs as predictive metrics for healthcare planning and prevention strategies[11, 26]. Combining robust analysis with policy recommendations, this study serves as a framework for addressing the rising health challenges posed by falls.

The study demonstrates several key strengths that enhance its rigor and relevance. First, the use of comprehensive GBD 2021 data ensures a robust analysis of falls-related burdens. Second, advanced statistical methods, including Joinpoint regression, Age-Period-Cohort modeling, and Bayesian predictive modeling, allow for precise exploration of temporal trends, demographic disparities, and future projections. Finally, the comparative focus on China provides valuable insights into its unique epidemiological patterns relative to global trends, addressing key gaps in the literature.

However, several limitations should be noted. First, reliance on GBD 2021 data may introduce biases due to regional data variability. Second, projections based on historical trends might overlook unforeseen changes in policies or behaviors. Third, residual confounding may persist despite advanced statistical methods, particularly in interpreting age-period-cohort effects. Finally, the focus on China and global patterns limits generalizability to other regions. Addressing these limitations in future research could improve the robustness and applicability of findings for fall prevention strategies.

To address these limitations, future research should improve regional data quality, adopt dynamic modeling frameworks, and address residual confounding. Expanding the geographic scope and integrating epidemiological, clinical, and policy perspectives will enhance the global applicability of the findings and contribute to mitigating falls-related burdens.

4. Conclusions

This study utilizes advanced statistical methods and GBD 2021 data to analyze trends and projections of falls-related burdens in adults aged 60 and older. The findings reveal a rising incidence and prevalence of falls in China, particularly among males, while global trends show stabilization in mortality and DALYs. Emphasizing demographic risks, the study highlights the urgent need for targeted interventions and predictive metrics to address the growing challenges posed by falls.

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Funding: This study was funded by the Wuhan University Medical Takeoff Project (TFLC2018001), titled “Collaborative Innovation in Neuroscience Disease and Function Research”