Fall-Related Injuries in Older Adult Cancer Survivors : A Decade of Racial Disparities

Fall-Related Injuries in Older Adult Cancer Survivors : A Decade of Racial Disparities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fall-Related Injuries in Older Adult Cancer Survivors : A Decade of Racial Disparities Asmaa Namoos, Nicholas Thomson, Vanessa Sheppard, Michel Aboutanos This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4979156/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: As the population ages and the number of cancer survivors in the USA continues to rise, fall-related injuries are becoming an increasingly critical public health issue. The purpose of this study is to assess the incidence and prevalence of fall-related injuries among older adult cancer survivors, with a particular focus on identifying and understanding racial disparities in fall risk between Black and White cohorts. Methods: A retrospective cohort study using data from 19,370 older adult cancer survivors aged 65 and above, extracted from the TriNetX network at Virginia Commonwealth University Health System (VCUHS). The study spanned from January 1, 2013, to December 31, 2023. Demographic information, including age, sex, race, and ethnicity, as well as ICD-10 codes for cancer history and fall-related injuries, were analyzed. Incidence rates were calculated as cases per person-day. Results: The study found that 7% of the cancer survivors experienced a new fall-related injury, with a prevalence rate of 8% over the study period. The incidence rate was calculated at 0.00005432 cases per person-day. Black or African American survivors exhibited a higher fall risk (4.915%) compared to their White counterparts (4.048%), with a statistically significant risk difference of 0.867% (95% CI: 0.199% to 1.534%). Discussion The findings of this study are consistent with existing literature that highlights the increased fall risk among older adult cancer survivors. The observed racial disparities in fall-related injuries underscore the need for targeted interventions that address the specific challenges faced by minority populations. The study's large sample size and comprehensive dataset strengthen the generalizability of the results, although the reliance on automated ICD-10 coding presents a potential limitation in data accuracy. Conclusions This study reveals significant racial disparities in fall-related injuries among older adult cancer survivors, particularly between Black and White individuals. The findings suggest the need for culturally sensitive and equitable healthcare strategies to improve the quality of life for all cancer survivors. Background Fall-related injuries are a critical public health issue that disproportionately affects cancer survivors, who often experience unique physical and functional declines due to their disease and its treatments 1 . Over the last decade, advancements in cancer care have significantly improved survival rates, leading to an increasing population of cancer survivors who may face long-term health challenges, including an elevated risk of falls 2 , 3 . Fall risk is influenced by factors such as muscle weakness, neuropathy, and bone fragility, often exacerbated by cancer treatments like chemotherapy, radiation, or surgery 4 . Studies indicate that cancer survivors, regardless of cancer type, face a higher risk of falls compared to the general population, with rates as high as 60% in some cohorts 5 . Demographic variables significantly impact the risk of falls 6 . Research shows that minority cancer survivors may experience higher fall rates due to disparities in access to care, quality of treatment, and the subsequent management of side effects, which directly contribute to fall risk 7 . For example, African American and Hispanic cancer survivors might receive less comprehensive follow-up care, potentially leading to unmanaged side effects such as neuropathy or muscle weakness, both of which elevate the risk of falls 8 . Moreover, socioeconomic factors linked to different racial and ethnic groups further influence the risk and consequences of falls. These factors include variations in living conditions, such as housing quality and neighborhood walkability, both of which are essential for ensuring safe mobility, particularly for individuals weakened by cancer treatments 9 . In addition to racial and socioeconomic disparities, gender differences can be a significant variable affecting fall-related injury rates 10 . Women generally experiencing a higher incidence of falls among breast cancer survivors, where estrogen-lowering therapies contribute to decreased bone density, increasing the risk of fragility fractures 11 . However, men are not exempt from these risks, as male survivors, particularly those treated for prostate cancer with androgen-deprivation therapies, face similar issues of bone demineralization and muscle weakness. This underscores the need for targeted fall prevention strategies across genders 12 . The purpose of this study is to assess the incidence and prevalence of fall-related injuries among older adult cancer survivors over a decade, with a specific focus on understanding the demographic factors, including age, sex, race, and ethnicity, that contribute to fall risk. Additionally, the study aims to identify and quantify racial disparities in fall incidence, particularly between Black and White cancer survivor cohorts, to inform targeted prevention strategies and address the observed disparities in fall risk within this vulnerable population. Methods Study Design and Population . This retrospective cohort study utilizes a dataset of 19,370 older adults aged 65 years and above, specifically focusing on Black and White cancer survivors who have experienced falls, as identified through their medical records. The study period spans from January 1, 2013, to December 31, 2023. Data Collection . Data were extracted from the electronic health records (EHRs) available through the TriNetX network at Virginia Commonwealth University Health System (VCUHS). The dataset includes detailed demographic information (age, sex, race, and ethnicity), diagnosis codes (ICD-10) related to survivors who had malignant cancers, and records of fall-related injuries, specifically identifying cases where patients arrived at the emergency room (ER) with injuries classified as severe or related to older adult falls. The EHR data encompasses comprehensive patient records, capturing a wide range of clinical variables essential for robust epidemiological analysis. Diagnosis codes were based on the International Classification of Diseases, 10th Revision (ICD-10), ensuring standardized and accurate identification of medical conditions. Data extraction was facilitated by the informatics team at Virginia Commonwealth University's (VCU). Kenneth and Dianne Wright Center for Clinical and Translational Research. Their support ensured the accuracy and completeness of the dataset, enabling detailed analysis of patient outcomes. The observational informatics program at VCUHS provided secure access to the TriNetX database, adhering to stringent data governance protocols designed to protect patient privacy and comply with regulatory standards. This program ensured that all data handling processes met ethical and legal requirements, guaranteeing the integrity and confidentiality of patient information. Statistical Analysis. Our analysis was conducted on the TriNetX platform. We employed descriptive statistics to summarize the demographic characteristics of the study population. Continuous variables such as age were expressed as means and standard deviations, while categorical variables including sex, race, and ethnicity were reported as frequencies and percentages. Incidence rates were calculated as the number of new cases per person-day, providing a measure of the risk of developing fall-related injuries among the study population. Software and Tools . Data analysis was conducted using the analytical tools available within the TriNetX network. These tools facilitated the processing and analysis of large datasets, enabling comprehensive statistical evaluations and visualizations. Results The study encompassed 19,370 cancer survivors over a decade, aged between 65 and 89 years. The mean age of participants was 79 years, with a standard deviation of 8 years, highlighting the predominantly older adult cohort at heightened risk of fall-related injuries. The demographic breakdown (Table 1 ) revealed a slight male predominance with 51.17% males (n = 9,911) and 48.83% females (n = 9,459), with no participants categorized under unknown sex. In terms of racial composition, 72.69% of the participants were White (n = 14,096), while 27.31% were Black or African American (n = 5,285), reflecting significant racial diversity within the study group. Ethnicity data showed that 0.72% were Hispanic or Latino (n = 140), 98.25% were not Hispanic or Latino (n = 19,037), and 1.03% had unknown ethnicity (n = 193). Table 1 Descriptive Analysis of Demographic of Cancer Survivor Variable Category N = 19,370 %=100 Sex Female 9,459 48.83% Male 9,911 51.21% Unknown 0 0.00% Race White 14,096 72.69% Black or African American 5,285 27.31% Ethnicity Hispanic or Latino 140 0.72% Not Hispanic or Latino 19,037 98.25% Unknown Ethnicity 193 1.03% Incidence and Prevalence of Fall-Related Injuries Among Cancer Survivors Aged 65 and Above, Stratified by Age, Sex, Race, and Ethnicity (2013–2023) The study conducted over a decade reveals significant findings regarding fall-related injuries among older adult cancer survivors. In Table 2 . The incidence proportion stands at 0.07005254, indicating that about 7% of the population experienced a new fall-related injury. The prevalence rate was slightly higher at 0.07919075, suggesting that nearly 8% of the survivors had fall-related injuries at any point in the given time frame. Additionally, the incidence rate measured as cases per person-day was 0.00005432, underscoring a continuous risk and occurrence of new fall injuries among this demographic. The study delineates clear trends in the incidence and prevalence of fall-related injuries among cancer survivors, with noticeable differences across age groups. For those aged 65–69 years, the incidence proportion stood at 0.0627, with a prevalence of 0.0712 and an incidence rate of approximately 4.80 cases per person-day. As age increased, so did the incidence and prevalence rates; the group aged 80–84 exhibited the highest figures, with an incidence proportion of 0.1102, prevalence of 0.1285, and an incidence rate of 9.32 cases per person-day, indicating a heightened vulnerability among the oldest subsets of the population. Transitioning from age to sex-related differences, the data show that males had a slightly higher incidence rate at 5.67 cases per person-day compared to females, who had a rate of 5.19 cases per person-day. Despite this, females exhibited a higher prevalence rate of 0.0797, suggesting that while fewer females may experience falls, those who do fall tend to do so repeatedly. This contrast highlights the nuanced differences in fall dynamics between genders. In terms of race, Black or African American survivors exhibited both higher incidence proportions and prevalence rates (0.0759 and 0.0896, respectively) compared to their White counterparts, who showed incidence proportions and prevalence rates of 0.0687 and 0.0753, respectively. This disparity may reflect underlying socio-economic and healthcare access differences that affect recovery and preventive care availability. Ethnic differences further accentuate disparities, with Hispanic or Latino survivors experiencing the highest incidence rate at 0.156 cases per person-day, significantly outpacing their Non-Hispanic or Latino peers who recorded an incidence rate of 5.45 cases per person-day. This stark contrast may be influenced by cultural, linguistic, and systemic barriers that affect health outcomes and access to preventive measures. Conversely, individuals of unknown ethnicity had the lowest figures in all categories, indicating potential issues in data capture or healthcare engagement. Table 2 Incidence and Prevalence of Fall-Related Injuries Among Cancer Survivors Aged 65 and Above, Stratified by Age, Sex, Race, and Ethnicity (2013–2023) Variable Category Incidence Proportion Prevalence Incidence Rate (cases/person-day) Overall 0.07005254 0.07919075 5.431524E-5 Age Group 65–69 0.06269593 0.071207434 4.7957765E-5 70–74 0.07633588 0.08712121 5.8963567E-5 75–79 0.102564104 0.11167513 8.054279E-5 80–84 0.11020408 0.12851405 9.3233975E-5 Sex Female 0.068509616 0.07966706 5.186841E-5 Male 0.071428575 0.07874016 5.6736822E-5 Race Black or African American 0.07592191 0.08955224 5.542092E-5 White 0.0686901 0.07533704 5.4506472E-5 Ethnicity Hispanic or Latino 0.07692308 0.07692308 1.5581421E-4 Not Hispanic or Latino 0.07070707 0.079458505 5.4530123E-5 Unknown Ethnicity 0.055555556 0.055555556 4.8480382E-5 Comparative Analysis of Fall Incidence Between Black and White Cancer Survivor Cohorts Table 3 provided statistical data compares the incidence of falls between Black and White cancer survivor cohorts. Within the Black Cancer Survivor cohort, which includes 5,290 patients, 260 patients experienced falls, resulting in a fall risk of 4.915%. Conversely, the White Cancer Survivor cohort, encompassing 14,080 patients, documented 570 falls, corresponding to a risk of 4.048%. The risk difference between the cohorts is 0.867% (95% CI: 0.199–1.534%), indicating a statistically significant higher risk of falls among Black cancer survivors compared to their White counterparts. The risk ratio and odds ratio are 1.214 (95% CI: 1.052 to 1.401) and 1.225 (95% CI: 1.054 to 1.424), respectively, suggesting the likelihood of falls is about 21–22% higher in the Black cohort. The statistical significance of these findings is confirmed with a p-value of 0.0080, highlighting a notable disparity in fall incidence between the two groups. Table 3 Measures of Association for Fall Incidence in Cancer Survivor Cohorts Cohort Patients in Cohort Patients with Outcome Risk Risk Difference 95% CI of Risk Difference Z-Value P-Value Risk Ratio 95% CI of Risk Ratio Odds Ratio 95% CI of Odds Ratio Black Cancer Survivor Cohort 5,290 260 4.915% 0.867% (0.199%, 1.534%) 2.654 0.0080 1.214 (1.052, 1.401) 1.225 (1.054, 1.424) White Cancer Survivor Cohort 14,080 570 4.048% Discussion This study provides a comprehensive analysis of fall-related injuries among older adult cancer survivors, emphasizing the significant disparities that exist across different demographic groups, particularly between Black and White cancer survivors. The study’s demographic analysis highlights that the majority of the 19,370 cancer survivors were older adults. The slight male predominance and significant racial diversity within the cohort, particularly with 27.31% being Black or African American and most of them are non-Hispanic. Our finding that approximately 7% of the cancer survivor population experienced a new fall-related injury aligns with the literature, which consistently reports higher fall rates among older adults with cancer compared to the general population. This elevated risk is largely attributed to the long-term effects of cancer treatments, such as chemotherapy-induced peripheral neuropathy and radiation-induced bone density loss, which significantly impair balance and mobility​ 13 , 14 . The literature also supports our observation that fall risk increases with age, particularly in individuals over 80 years old, who experience the highest incidence rates of fall-related injuries. This trend is well-documented and reflects the cumulative effects of aging and cancer treatment on physical health 15 . Regarding racial disparities, our study found that Black or African American cancer survivors had higher incidence and prevalence rates of falls compared to their White counterparts. This finding is corroborated by previous research indicating that minority groups, particularly African Americans, often experience worse health outcomes, including higher fall rates, due to a combination of socio-economic factors, reduced access to healthcare, and differences in the quality of care received​ 16 – 19 . Investigating further into the health challenges faced by the Black or African American community reveals significant disparities in cancer outcomes and related health risks, including fall-related injuries. Our study contributes to this understanding by demonstrating that Black cancer survivors experience a notably higher risk of falls compared to their White counterparts, with a fall risk difference of 0.867%. This finding is consistent with broader research that highlights the disproportionate burden of poorer health outcomes and increased vulnerability to injuries among Black individuals, often linked to systemic socio-economic factors and unequal access to healthcare 21 , 22 ​. However, the literature also notes some variability in fall rates among different racial groups, suggesting that other factors, such as cultural practices and community support, may influence fall risk​ 14 . The higher incidence of falls related injury rate among Hispanic or Latino cancer survivors observed in our study is consistent with findings that suggest cultural and systemic barriers may limit access to fall prevention resources and adequate follow-up care for this group​ 10 , 20 . Strengths One of the primary strengths of this study lies in its large sample size, encompassing 19,370 older adult cancer survivors, which enhances the generalizability of the findings across this vulnerable population. The use of a comprehensive dataset from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) allowed for detailed demographic analysis, providing insights into the incidence and prevalence of fall-related injuries stratified by age, sex, race, and ethnicity. The inclusion of ICD-10 codes to identify specific cancer types and fall-related injuries ensures a high level of accuracy in capturing relevant clinical outcomes, further strengthening the validity of the study's findings. Additionally, the decade-long study period provides a robust temporal framework to observe trends and shifts in fall risk, making the results more reliable and reflective of long-term patterns. Limitations While the inclusion of ICD-10 codes to identify specific cancer types and fall-related injuries enhances the accuracy of capturing relevant clinical outcomes, there is a limitation in that these codes are sometimes assigned automatically to patients, which may lead to potential misclassification or inaccuracies in the data. The reliance on automated coding systems for assigning ICD-10 codes may introduce variability in data quality, potentially impacting the study’s findings. Such variability could lead to misclassification or inaccuracies in identifying specific cancer types and fall-related injuries. Moreover, while the decade-long study period offers a comprehensive temporal framework, it may also reflect changes in coding practices or healthcare delivery over time. These factors could influence the observed trends, necessitating a careful and cautious interpretation of the results. Conclusion Our study highlights significant disparities in fall-related injuries among older adult cancer survivors, particularly between Black and White individuals. The findings emphasize the need for targeted interventions that address the unique risks associated with aging, race, and cancer treatment. Despite the limitations related to automated ICD-10 coding and potential shifts in healthcare practices over the decade, the study provides valuable insights into the persistent challenges faced by this vulnerable population. These results underscore the importance of developing culturally sensitive and equitable healthcare strategies to mitigate fall risk and improve outcomes for all cancer survivors. Abbreviations VCUHS: Virginia Commonwealth University Health System ICD-10: International Classification of Diseases, 10th Revision EHR: Electronic Health Records Declarations Clinical Trial Number: Not applicable Ethics Approval and Consent to Participate Ethical approval for this study was obtained from the Institutional Review Board (IRB) at Virginia Commonwealth University, classified as a non-human subject submission to ensure adherence to ethical guidelines and patient confidentiality. As this study involved retrospective analysis of de-identified data, patient consent was not required. Consent for Publication : Not applicable. Availability of Data and Materials ; The datasets generated and/or analyzed during the current study were extracted from the TriNetX database. These datasets are available from the corresponding author on reasonable request, subject to privacy and ethical restrictions. Competing Interests : The authors declare that they have no competing interests. Funding : This work was supported by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research at Virginia Commonwealth University under the Clinical and Translational Science Award (CTSA) Grant number UM1TR004360. Authors' Contributions Asmaa Namoos, MD, MPH, PhD : Conceptualized the study, led the data analysis, and drafted the manuscript. Nicholas Thomson, PhD : Provided methodological support and critical revisions to the manuscript. Vanessa Sheppard, PhD : Assisted in the interpretation of the results and contributed to the manuscript's writing. Michel Aboutanos, MPH, MD : Supervised the study, contributed to the study design, and reviewed the manuscript for intellectual content. All authors have read and approved the final manuscript. Acknowledgements We extend our gratitude to the informatics team at Virginia Commonwealth University's (VCU) C. Kenneth and Dianne Wright Center for Clinical and Translational Research, especially Dr. Tamas Gal and his team members Evan French and Patrick Shi, for their invaluable support in data extraction through the TriNetX platform. References Zhao J, Wang G, Chen L, Yu S, Li W. Risk factors for falls in hospitalized patients with cancer: A systematic review and meta-analysis. Asia-Pac J Oncol Nurs . 2022;9(8):100107. doi:10.1016/j.apjon.2022.100107 Miller K. Cancer treatment and survivorship statistics, 2022 - Miller - 2022 - CA: A Cancer Journal for Clinicians - Wiley Online Library. 2022. Accessed August 13, 2024. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21731 Fitch MI, Nicoll I, Newton L, Strohschein FJ. Challenges of Survivorship for Older Adults Diagnosed with Cancer. Curr Oncol Rep . 2022;24(6):763-773. doi:10.1007/s11912-022-01255-7 Morris R, Lewis A. Falls and Cancer. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4979156","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":360332996,"identity":"1fe84a9b-5f9c-4ced-8237-ce7361955b86","order_by":0,"name":"Asmaa Namoos","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHklEQVRIiWNgGAWjYBACNgh1GEJ9AGIDBgbGA4wNuLXwQ6jHYJJxBkQLw4GDeLRIQuQ+g0lmHmK0GJw/nfjhB8Nned325sOfbdvsErezNz84/HEHg5x5/wLsWm7kbpbsYbhtuO3MsTTp3LbkxJ09xwwOHDzDYCxz4wEOLbwbJHgYbjNuu5Fjxpxz5kDihhsJQC1tDIkzJA5g1WJ//uzmn38YztsDtRh/tgBpuf/8A14tBgdyt0nzMBxPBGoxkGaoANnCA7WFH3sYAP2yzVrG4HgyyC+SPRXJxhvO5BQcONsmYSwhgSvEzm6++abisO22482HP/wwsJPdcPz4xgeVbTZyEvzYHQbViCkEtEIiAY8W7ACvLaNgFIyCUTCCAACy83S8O+BsYwAAAABJRU5ErkJggg==","orcid":"","institution":"Virginia Commonwealth University Medical Center West Hospital","correspondingAuthor":true,"prefix":"","firstName":"Asmaa","middleName":"","lastName":"Namoos","suffix":""},{"id":360332997,"identity":"8f52576e-ba04-4044-a19c-992b352ac903","order_by":1,"name":"Nicholas Thomson","email":"","orcid":"","institution":"Virginia Commonwealth University Medical Center West Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Thomson","suffix":""},{"id":360332998,"identity":"f88538da-4b65-463f-9fa0-f28e8968298b","order_by":2,"name":"Vanessa Sheppard","email":"","orcid":"","institution":"Virginia Commonwealth University Medical Center West Hospital","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Sheppard","suffix":""},{"id":360332999,"identity":"de414b72-ba2b-44cc-868c-475d90bb04e2","order_by":3,"name":"Michel Aboutanos","email":"","orcid":"","institution":"Virginia Commonwealth University Medical Center West Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michel","middleName":"","lastName":"Aboutanos","suffix":""}],"badges":[],"createdAt":"2024-08-26 15:49:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4979156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4979156/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65896833,"identity":"e9612ede-980d-4fb6-aa46-e8ce3622c90e","added_by":"auto","created_at":"2024-10-04 06:43:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":538438,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4979156/v1/8e32639b-3bf4-44ba-b9af-751f3f2ca10d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fall-Related Injuries in Older Adult Cancer Survivors : A Decade of Racial Disparities","fulltext":[{"header":"Background","content":"\u003cp\u003eFall-related injuries are a critical public health issue that disproportionately affects cancer survivors, who often experience unique physical and functional declines due to their disease and its treatments\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Over the last decade, advancements in cancer care have significantly improved survival rates, leading to an increasing population of cancer survivors who may face long-term health challenges, including an elevated risk of falls\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Fall risk is influenced by factors such as muscle weakness, neuropathy, and bone fragility, often exacerbated by cancer treatments like chemotherapy, radiation, or surgery\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudies indicate that cancer survivors, regardless of cancer type, face a higher risk of falls compared to the general population, with rates as high as 60% in some cohorts \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Demographic variables significantly impact the risk of falls\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Research shows that minority cancer survivors may experience higher fall rates due to disparities in access to care, quality of treatment, and the subsequent management of side effects, which directly contribute to fall risk \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. For example, African American and Hispanic cancer survivors might receive less comprehensive follow-up care, potentially leading to unmanaged side effects such as neuropathy or muscle weakness, both of which elevate the risk of falls\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, socioeconomic factors linked to different racial and ethnic groups further influence the risk and consequences of falls. These factors include variations in living conditions, such as housing quality and neighborhood walkability, both of which are essential for ensuring safe mobility, particularly for individuals weakened by cancer treatments\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to racial and socioeconomic disparities, gender differences can be a significant variable affecting fall-related injury rates\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Women generally experiencing a higher incidence of falls among breast cancer survivors, where estrogen-lowering therapies contribute to decreased bone density, increasing the risk of fragility fractures\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, men are not exempt from these risks, as male survivors, particularly those treated for prostate cancer with androgen-deprivation therapies, face similar issues of bone demineralization and muscle weakness. This underscores the need for targeted fall prevention strategies across genders \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe purpose of this study\u003c/span\u003e is to assess the incidence and prevalence of fall-related injuries among older adult cancer survivors over a decade, with a specific focus on understanding the demographic factors, including age, sex, race, and ethnicity, that contribute to fall risk. Additionally, the study aims to identify and quantify racial disparities in fall incidence, particularly between Black and White cancer survivor cohorts, to inform targeted prevention strategies and address the observed disparities in fall risk within this vulnerable population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStudy Design and Population\u003c/span\u003e. This retrospective cohort study utilizes a dataset of 19,370 older adults aged 65 years and above, specifically focusing on Black and White cancer survivors who have experienced falls, as identified through their medical records. The study period spans from January 1, 2013, to December 31, 2023.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData Collection\u003c/span\u003e. Data were extracted from the electronic health records (EHRs) available through the TriNetX network at Virginia Commonwealth University Health System (VCUHS). The dataset includes detailed demographic information (age, sex, race, and ethnicity), diagnosis codes (ICD-10) related to survivors who had malignant cancers, and records of fall-related injuries, specifically identifying cases where patients arrived at the emergency room (ER) with injuries classified as severe or related to older adult falls.\u003c/p\u003e \u003cp\u003eThe EHR data encompasses comprehensive patient records, capturing a wide range of clinical variables essential for robust epidemiological analysis. Diagnosis codes were based on the International Classification of Diseases, 10th Revision (ICD-10), ensuring standardized and accurate identification of medical conditions. Data extraction was facilitated by the informatics team at Virginia Commonwealth University's (VCU). Kenneth and Dianne Wright Center for Clinical and Translational Research. Their support ensured the accuracy and completeness of the dataset, enabling detailed analysis of patient outcomes.\u003c/p\u003e \u003cp\u003e The observational informatics program at VCUHS provided secure access to the TriNetX database, adhering to stringent data governance protocols designed to protect patient privacy and comply with regulatory standards. This program ensured that all data handling processes met ethical and legal requirements, guaranteeing the integrity and confidentiality of patient information.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStatistical Analysis.\u003c/span\u003e Our analysis was conducted on the TriNetX platform. We employed descriptive statistics to summarize the demographic characteristics of the study population. Continuous variables such as age were expressed as means and standard deviations, while categorical variables including sex, race, and ethnicity were reported as frequencies and percentages. Incidence rates were calculated as the number of new cases per person-day, providing a measure of the risk of developing fall-related injuries among the study population.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSoftware and Tools\u003c/span\u003e. Data analysis was conducted using the analytical tools available within the TriNetX network. These tools facilitated the processing and analysis of large datasets, enabling comprehensive statistical evaluations and visualizations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study encompassed 19,370 cancer survivors over a decade, aged between 65 and 89 years. The mean age of participants was 79 years, with a standard deviation of 8 years, highlighting the predominantly older adult cohort at heightened risk of fall-related injuries. The demographic breakdown (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) revealed a slight male predominance with 51.17% males (n\u0026thinsp;=\u0026thinsp;9,911) and 48.83% females (n\u0026thinsp;=\u0026thinsp;9,459), with no participants categorized under unknown sex.\u003c/p\u003e \u003cp\u003eIn terms of racial composition, 72.69% of the participants were White (n\u0026thinsp;=\u0026thinsp;14,096), while 27.31% were Black or African American (n\u0026thinsp;=\u0026thinsp;5,285), reflecting significant racial diversity within the study group. Ethnicity data showed that 0.72% were Hispanic or Latino (n\u0026thinsp;=\u0026thinsp;140), 98.25% were not Hispanic or Latino (n\u0026thinsp;=\u0026thinsp;19,037), and 1.03% had unknown ethnicity (n\u0026thinsp;=\u0026thinsp;193).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Analysis of Demographic of Cancer Survivor\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19,370\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%=100\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.83%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14,096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHispanic or Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Hispanic or Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19,037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.03%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIncidence and Prevalence of Fall-Related Injuries Among Cancer Survivors Aged 65 and Above, Stratified by Age, Sex, Race, and Ethnicity (2013\u0026ndash;2023)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study conducted over a decade reveals significant findings regarding fall-related injuries among older adult cancer survivors. In Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The incidence proportion stands at 0.07005254, indicating that about 7% of the population experienced a new fall-related injury. The prevalence rate was slightly higher at 0.07919075, suggesting that nearly 8% of the survivors had fall-related injuries at any point in the given time frame. Additionally, the incidence rate measured as cases per person-day was 0.00005432, underscoring a continuous risk and occurrence of new fall injuries among this demographic.\u003c/p\u003e \u003cp\u003eThe study delineates clear trends in the incidence and prevalence of fall-related injuries among cancer survivors, with noticeable differences across age groups. For those aged 65\u0026ndash;69 years, the incidence proportion stood at 0.0627, with a prevalence of 0.0712 and an incidence rate of approximately 4.80 cases per person-day. As age increased, so did the incidence and prevalence rates; the group aged 80\u0026ndash;84 exhibited the highest figures, with an incidence proportion of 0.1102, prevalence of 0.1285, and an incidence rate of 9.32 cases per person-day, indicating a heightened vulnerability among the oldest subsets of the population.\u003c/p\u003e \u003cp\u003eTransitioning from age to sex-related differences, the data show that males had a slightly higher incidence rate at 5.67 cases per person-day compared to females, who had a rate of 5.19 cases per person-day. Despite this, females exhibited a higher prevalence rate of 0.0797, suggesting that while fewer females may experience falls, those who do fall tend to do so repeatedly. This contrast highlights the nuanced differences in fall dynamics between genders.\u003c/p\u003e \u003cp\u003eIn terms of race, Black or African American survivors exhibited both higher incidence proportions and prevalence rates (0.0759 and 0.0896, respectively) compared to their White counterparts, who showed incidence proportions and prevalence rates of 0.0687 and 0.0753, respectively. This disparity may reflect underlying socio-economic and healthcare access differences that affect recovery and preventive care availability.\u003c/p\u003e \u003cp\u003eEthnic differences further accentuate disparities, with Hispanic or Latino survivors experiencing the highest incidence rate at 0.156 cases per person-day, significantly outpacing their Non-Hispanic or Latino peers who recorded an incidence rate of 5.45 cases per person-day. This stark contrast may be influenced by cultural, linguistic, and systemic barriers that affect health outcomes and access to preventive measures. Conversely, individuals of unknown ethnicity had the lowest figures in all categories, indicating potential issues in data capture or healthcare engagement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence and Prevalence of Fall-Related Injuries Among Cancer Survivors Aged 65 and Above, Stratified by Age, Sex, Race, and Ethnicity (2013\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncidence Proportion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIncidence Rate (cases/person-day)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07005254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07919075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.431524E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06269593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071207434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7957765E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07633588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08712121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.8963567E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.102564104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11167513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.054279E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11020408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12851405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.3233975E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.068509616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07966706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.186841E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.071428575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07874016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.6736822E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07592191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08955224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.542092E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0686901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07533704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4506472E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHispanic or Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07692308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07692308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5581421E-4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Hispanic or Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07070707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.079458505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4530123E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.055555556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055555556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.8480382E-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eComparative Analysis of Fall Incidence Between Black and White Cancer Survivor Cohorts\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provided statistical data compares the incidence of falls between Black and White cancer survivor cohorts. Within the Black Cancer Survivor cohort, which includes 5,290 patients, 260 patients experienced falls, resulting in a fall risk of 4.915%. Conversely, the White Cancer Survivor cohort, encompassing 14,080 patients, documented 570 falls, corresponding to a risk of 4.048%. The risk difference between the cohorts is 0.867% (95% CI: 0.199\u0026ndash;1.534%), indicating a statistically significant higher risk of falls among Black cancer survivors compared to their White counterparts. The risk ratio and odds ratio are 1.214 (95% CI: 1.052 to 1.401) and 1.225 (95% CI: 1.054 to 1.424), respectively, suggesting the likelihood of falls is about 21\u0026ndash;22% higher in the Black cohort. The statistical significance of these findings is confirmed with a p-value of 0.0080, highlighting a notable disparity in fall incidence between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeasures of Association for Fall Incidence in Cancer Survivor Cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients in Cohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients with Outcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRisk\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRisk Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI of Risk Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eZ-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRisk Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e95% CI of Risk Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e95% CI of Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack Cancer Survivor Cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.915%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.867%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e(0.199%, 1.534%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e(1.052, 1.401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e(1.054, 1.424)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite Cancer Survivor Cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14,080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.048%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a comprehensive analysis of fall-related injuries among older adult cancer survivors, emphasizing the significant disparities that exist across different demographic groups, particularly between Black and White cancer survivors. The study\u0026rsquo;s demographic analysis highlights that the majority of the 19,370 cancer survivors were older adults. The slight male predominance and significant racial diversity within the cohort, particularly with 27.31% being Black or African American and most of them are non-Hispanic.\u003c/p\u003e \u003cp\u003eOur finding that approximately 7% of the cancer survivor population experienced a new fall-related injury aligns with the literature, which consistently reports higher fall rates among older adults with cancer compared to the general population. This elevated risk is largely attributed to the long-term effects of cancer treatments, such as chemotherapy-induced peripheral neuropathy and radiation-induced bone density loss, which significantly impair balance and mobility​ \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The literature also supports our observation that fall risk increases with age, particularly in individuals over 80 years old, who experience the highest incidence rates of fall-related injuries. This trend is well-documented and reflects the cumulative effects of aging and cancer treatment on physical health\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding racial disparities, our study found that Black or African American cancer survivors had higher incidence and prevalence rates of falls compared to their White counterparts. This finding is corroborated by previous research indicating that minority groups, particularly African Americans, often experience worse health outcomes, including higher fall rates, due to a combination of socio-economic factors, reduced access to healthcare, and differences in the quality of care received​\u003csup\u003e\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Investigating further into the health challenges faced by the Black or African American community reveals significant disparities in cancer outcomes and related health risks, including fall-related injuries. Our study contributes to this understanding by demonstrating that Black cancer survivors experience a notably \u003cb\u003ehigher risk\u003c/b\u003e of falls compared to their White counterparts, with a fall risk difference of 0.867%. This finding is consistent with broader research that highlights the disproportionate burden of poorer health outcomes and increased vulnerability to injuries among Black individuals, often linked to systemic socio-economic factors and unequal access to healthcare\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e​.\u003c/p\u003e \u003cp\u003eHowever, the literature also notes some variability in fall rates among different racial groups, suggesting that other factors, such as cultural practices and community support, may influence fall risk​ \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The higher incidence of falls related injury rate among Hispanic or Latino cancer survivors observed in our study is consistent with findings that suggest cultural and systemic barriers may limit access to fall prevention resources and adequate follow-up care for this group​ \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStrengths\u003c/strong\u003e \u003cp\u003eOne of the primary strengths of this study lies in its large sample size, encompassing 19,370 older adult cancer survivors, which enhances the generalizability of the findings across this vulnerable population. The use of a comprehensive dataset from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) allowed for detailed demographic analysis, providing insights into the incidence and prevalence of fall-related injuries stratified by age, sex, race, and ethnicity. The inclusion of ICD-10 codes to identify specific cancer types and fall-related injuries ensures a high level of accuracy in capturing relevant clinical outcomes, further strengthening the validity of the study's findings. Additionally, the decade-long study period provides a robust temporal framework to observe trends and shifts in fall risk, making the results more reliable and reflective of long-term patterns.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eWhile the inclusion of ICD-10 codes to identify specific cancer types and fall-related injuries enhances the accuracy of capturing relevant clinical outcomes, there is a limitation in that these codes are sometimes assigned automatically to patients, which may lead to potential misclassification or inaccuracies in the data. The reliance on automated coding systems for assigning ICD-10 codes may introduce variability in data quality, potentially impacting the study\u0026rsquo;s findings. Such variability could lead to misclassification or inaccuracies in identifying specific cancer types and fall-related injuries. Moreover, while the decade-long study period offers a comprehensive temporal framework, it may also reflect changes in coding practices or healthcare delivery over time. These factors could influence the observed trends, necessitating a careful and cautious interpretation of the results.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlights significant disparities in fall-related injuries among older adult cancer survivors, particularly between Black and White individuals. The findings emphasize the need for targeted interventions that address the unique risks associated with aging, race, and cancer treatment. Despite the limitations related to automated ICD-10 coding and potential shifts in healthcare practices over the decade, the study provides valuable insights into the persistent challenges faced by this vulnerable population. These results underscore the importance of developing culturally sensitive and equitable healthcare strategies to mitigate fall risk and improve outcomes for all cancer survivors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eVCUHS:\u003c/strong\u003e Virginia Commonwealth University Health System\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eICD-10:\u003c/strong\u003e International Classification of Diseases, 10th Revision\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEHR:\u003c/strong\u003e Electronic Health Records\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board (IRB) at Virginia Commonwealth University, classified as a non-human subject submission to ensure adherence to ethical guidelines and patient confidentiality. As this study involved retrospective analysis of de-identified data, patient consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e; The datasets generated and/or analyzed during the current study were extracted from the TriNetX database. These datasets are available from the corresponding author on reasonable request, subject to privacy and ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This work was supported by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research at Virginia Commonwealth University under the Clinical and Translational Science Award (CTSA) Grant number UM1TR004360.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAsmaa Namoos, MD, MPH, PhD\u003c/strong\u003e: Conceptualized the study, led the data analysis, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNicholas Thomson, PhD\u003c/strong\u003e: Provided methodological support and critical revisions to the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVanessa Sheppard, PhD\u003c/strong\u003e: Assisted in the interpretation of the results and contributed to the manuscript\u0026apos;s writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMichel Aboutanos, MPH, MD\u003c/strong\u003e: Supervised the study, contributed to the study design, and reviewed the manuscript for intellectual content.\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to the informatics team at Virginia Commonwealth University\u0026apos;s (VCU) C. Kenneth and Dianne Wright Center for Clinical and Translational Research, especially Dr. Tamas Gal and his team members Evan French and Patrick Shi, for their invaluable support in data extraction through the TriNetX platform.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhao J, Wang G, Chen L, Yu S, Li W. Risk factors for falls in hospitalized patients with cancer: A systematic review and meta-analysis. \u003cem\u003eAsia-Pac J Oncol Nurs\u003c/em\u003e. 2022;9(8):100107. doi:10.1016/j.apjon.2022.100107\u003c/li\u003e\n\u003cli\u003eMiller K. Cancer treatment and survivorship statistics, 2022 - Miller - 2022 - CA: A Cancer Journal for Clinicians - Wiley Online Library. 2022. Accessed August 13, 2024. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21731\u003c/li\u003e\n\u003cli\u003eFitch MI, Nicoll I, Newton L, Strohschein FJ. Challenges of Survivorship for Older Adults Diagnosed with Cancer. \u003cem\u003eCurr Oncol Rep\u003c/em\u003e. 2022;24(6):763-773. doi:10.1007/s11912-022-01255-7\u003c/li\u003e\n\u003cli\u003eMorris R, Lewis A. Falls and Cancer. \u003cem\u003eClin Oncol\u003c/em\u003e. 2020;32(9):569-578. doi:10.1016/j.clon.2020.03.011\u003c/li\u003e\n\u003cli\u003eWildes TM, Dua P, Fowler SA, et al. Systematic Review of Falls in Older Adults with Cancer. \u003cem\u003eJ Geriatr Oncol\u003c/em\u003e. 2015;6(1):70-83. doi:10.1016/j.jgo.2014.10.003\u003c/li\u003e\n\u003cli\u003eNamoos AM, Thomson N, Bradley S, Aboutanos M. The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults. \u003cem\u003eRes Sq\u003c/em\u003e. Published online July 19, 2024:rs.3.rs-4762014. doi:10.21203/rs.3.rs-4762014/v1\u003c/li\u003e\n\u003cli\u003eEllis KR, Black KZ, Baker S, et al. Racial differences in the influence of healthcare system factors on informal support for cancer care among Black and White breast and lung cancer survivors. \u003cem\u003eFam Community Health\u003c/em\u003e. 2020;43(3):200-212. doi:10.1097/FCH.0000000000000264\u003c/li\u003e\n\u003cli\u003eGuimond E, Getachew B, Nolan TS, Sheffield-Abdullah KM, Conklin JL, Hirschey R. Communication Between Black Patients With Cancer and Their Oncology Clinicians: Exploring Factors That Influence Outcome Disparities. \u003cem\u003eOncol Nurs Forum\u003c/em\u003e. 2022;49(6):509-524. doi:10.1188/22.ONF.509-524\u003c/li\u003e\n\u003cli\u003eLiu H, Hu T. Impact of socioeconomic status and health risk on fall inequality among older adults. \u003cem\u003eHealth Soc Care Community\u003c/em\u003e. 2022;30(6):e4961-e4974. doi:10.1111/hsc.13908\u003c/li\u003e\n\u003cli\u003eStevens J, Sogolow E. Gender differences for non-fatal unintentional fall related injuries among older adults. \u003cem\u003eInj Prev\u003c/em\u003e. 2005;11(2):115-119. doi:10.1136/ip.2004.005835\u003c/li\u003e\n\u003cli\u003eFessele KL. Bone health considerations in breast cancer. \u003cem\u003eSemin Oncol Nurs\u003c/em\u003e. 2022;38(2):151273. doi:10.1016/j.soncn.2022.151273\u003c/li\u003e\n\u003cli\u003eBone loss induced by cancer treatments in breast and prostate cancer patients - PMC. Accessed August 13, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522722/\u003c/li\u003e\n\u003cli\u003eSattar S, Haase K, Kuster S, et al. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. \u003cem\u003eSupport Care Cancer\u003c/em\u003e. 2021;29(1):21-33. doi:10.1007/s00520-020-05619-2\u003c/li\u003e\n\u003cli\u003eHan BH, Ferris R, Blaum C. Exploring Ethnic and Racial Differences in Falls Among Older Adults. \u003cem\u003eJ Community Health\u003c/em\u003e. 2014;39(6):1241-1247. doi:10.1007/s10900-014-9852-8\u003c/li\u003e\n\u003cli\u003ePrevention I of M (US) D of HP and D, Berg RL, Cassells JS. Falls in Older Persons: Risk Factors and Prevention. In: \u003cem\u003eThe Second Fifty Years: Promoting Health and Preventing Disability\u003c/em\u003e. National Academies Press (US); 1992. Accessed July 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK235613/\u003c/li\u003e\n\u003cli\u003eGeng Y, Lo JC, Brickner L, Gordon NP. Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2017;17(1):65. doi:10.1186/s12877-017-0447-y\u003c/li\u003e\n\u003cli\u003eEsnaola NF, Ford ME. Racial Differences and Disparities in Cancer Care and Outcomes: Where\u0026rsquo;s the Rub? \u003cem\u003eSurg Oncol Clin N Am\u003c/em\u003e. 2012;21(3):417-viii. doi:10.1016/j.soc.2012.03.012\u003c/li\u003e\n\u003cli\u003eCampbell G, Wolfe RA, Klem ML. Risk factors for falls in adult cancer survivors: An integrative review. \u003cem\u003eRehabil Nurs Off J Assoc Rehabil Nurses\u003c/em\u003e. 2018;43(4):201-213. doi:10.1097/rnj.0000000000000173\u003c/li\u003e\n\u003cli\u003eWinters-Stone KM, Horak F, Eisner A, Leo MC, Chui S, Luoh SW. Identifying factors associated with falls in postmenopausal breast cancer survivors: a multi-disciplinary approach. \u003cem\u003eArch Phys Med Rehabil\u003c/em\u003e. 2011;92(4):646-652. doi:10.1016/j.apmr.2010.10.039\u003c/li\u003e\n\u003cli\u003eSpoelstra S, Given B, von Eye A, Given C. Fall Risk in Community Dwelling Older adult Cancer Survivors\u0026mdash;A Predictive Model for Gerontological Nurses. \u003cem\u003eJ Gerontol Nurs\u003c/em\u003e. 2010;36(2):52-60. doi:10.3928/00989134-20100108-01\u003c/li\u003e\n\u003cli\u003eCancer Disparities - NCI. August 4, 2016. Accessed August 15, 2024. https://www.cancer.gov/about-cancer/understanding/disparities\u003c/li\u003e\n\u003cli\u003eFactors Influencing Cancer Disparities. American Cancer Society Cancer Action Network. January 11, 2024. Accessed August 15, 2024. https://www.fightcancer.org/policy-resources/factors-influencing-cancer-disparities\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4979156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4979156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e As the population ages and the number of cancer survivors in the USA continues to rise, fall-related injuries are becoming an increasingly critical public health issue. The purpose of this study is to assess the incidence and prevalence of fall-related injuries among older adult cancer survivors, with a particular focus on identifying and understanding racial disparities in fall risk between Black and White cohorts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cohort study using data from 19,370 older adult cancer survivors aged 65 and above, extracted from the TriNetX network at Virginia Commonwealth University Health System (VCUHS). The study spanned from January 1, 2013, to December 31, 2023. Demographic information, including age, sex, race, and ethnicity, as well as ICD-10 codes for cancer history and fall-related injuries, were analyzed. Incidence rates were calculated as cases per person-day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study found that 7% of the cancer survivors experienced a new fall-related injury, with a prevalence rate of 8% over the study period. The incidence rate was calculated at 0.00005432 cases per person-day. Black or African American survivors exhibited a higher fall risk (4.915%) compared to their White counterparts (4.048%), with a statistically significant risk difference of 0.867% (95% CI: 0.199% to 1.534%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study are consistent with existing literature that highlights the increased fall risk among older adult cancer survivors. The observed racial disparities in fall-related injuries underscore the need for targeted interventions that address the specific challenges faced by minority populations. The study's large sample size and comprehensive dataset strengthen the generalizability of the results, although the reliance on automated ICD-10 coding presents a potential limitation in data accuracy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reveals significant racial disparities in fall-related injuries among older adult cancer survivors, particularly between Black and White individuals. The findings suggest the need for culturally sensitive and equitable healthcare strategies to improve the quality of life for all cancer survivors.\u003c/p\u003e","manuscriptTitle":"Fall-Related Injuries in Older Adult Cancer Survivors : A Decade of Racial Disparities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-04 06:35:13","doi":"10.21203/rs.3.rs-4979156/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T07:03:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T06:50:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2026-04-24T07:54:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T18:09:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126330956271506780734603736746671460523","date":"2026-03-30T14:41:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-15T12:28:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172094419873719613458598396430186257174","date":"2024-10-15T12:16:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232118310522223107671388264294405685628","date":"2024-10-06T16:39:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-26T12:55:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-04T05:14:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-04T02:36:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-04T02:36:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-08-26T15:48:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5b10d61-67a9-4baf-8e29-bdc586fbb177","owner":[],"postedDate":"October 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T06:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-04 06:35:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4979156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4979156","identity":"rs-4979156","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}