Global, regional, and national burden of falls in middle-aged and elderly individuals from 1990 to 2021: findings from the Global Burden of Disease study 2021

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Data may be preliminary. 21 November 2025 V1 Latest version Share on Global, regional, and national burden of falls in middle-aged and elderly individuals from 1990 to 2021: findings from the Global Burden of Disease study 2021 Authors : Ziyue Zhou , Jingwei Zhou , Jingjing Li , Zihan Xue , Tao Wang , and Yunping Zhou 0000-0001-6132-7590 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176371934.46390336/v1 321 views 113 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: Falls represent a significant global public health challenge. This study aims to comprehensively assess the burden of falls among individuals aged 55 years and older and analyze its temporal trends from 1990 to 2021. Methods: In this analysis based on the Global Burden of Disease Study 2021, we reported the cases and rates of incidence, prevalence, deaths and disability-adjusted life years (DALYs) related to falls among individuals aged 55 years and older from 1990 to 2021, stratified by gender, age and Sociodemographic Index (SDI) quintiles. Results: From 1990 to 2021, the falls-related incidence, prevalence, deaths and DALYs among individuals aged 55 years and older demonstrated an upward trend globally. However, a downward trend in the prevalence and DALYs related to falls was observed between 2001 to 2011. Sex-specific analyses revealed that the relevant indicators related to falls showed an upward trend among females, while the falls-related prevalence and DALYs showed a downward trend among males. Individuals aged 80 years and older showed a disproportionately higher burden of falls compared to younger age subgroups. The falls-related incidence exhibited a significant increasing trend across different SDI countries. Regionally, although the falls-related incidence showed an increasing trend in most regions from 1990 to 2021, there were some regions with a decreasing trend. Conclusions: The burden of falls among individuals aged 55 years and older remains a critical public health challenge. These findings underscore the necessity of incorporating gender- and age-specific risk profiles into the design of targeted prevention and intervention strategies. Highlights: Individuals aged 55 years and older experiences a significant burden of falls. The falls-related incidence and DALYs exhibited an upward trend from 1990 to 2021. Developing targeted interventions for individuals aged 55-60 years is imperative. Global, regional, and national burden of falls in middle-aged and elderly individuals from 1990 to 2021: findings from the Global Burden of Disease study 2021 Running title: The burden of falls in middle-aged and elderly individuals. Ziyue Zhou a,b , Jingwei Zhou c , Jingjing Li a,b , Zihan Xue d , Tao Wang e,f* , Yunping Zhou a,b* Affiliations: a School of Nursing, Qingdao University, Qingdao, Shandong, 266071, China. b Qingdao Municipal Key Laboratory for Smart Healthcare and Chronic Disease Management, Qingdao, Shandong, China. c Department of Emergency Internal Medicine, Affiliated Hospital of Qingdao University, Qingdao, 266001, China. d School of Basic Medical Sciences, Qingdao University, Qingdao, Shandong, 266071, China. e School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China f Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China * Corresponding Author: Yunping Zhou, School of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, China. E-mail: [email protected] . Tel: 156 1512 8057. ORCID: 0000-0001-6132-7590. Tao Wang, School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China. E-mail: [email protected] . *These authors contributed equally to this work. Authors´ contributions Ziyue Zhou: Conceptualization, Data curation, Formal analysis, Software, Methodology, Writing – original draft. Jingwei Zhou: Methodology, Data curation. Jingjing Li: Methodology, Writing- original draft. Zihan Xue: Conceptualization, Formal analysis. Tao Wang: Data curation, Formal analysis, Methodology. Yunping Zhou: Conceptualization, Formal analysis, Methodology, Supervision, Writing- original draft, Writing- review and editing. Acknowledgments We appreciate the outstanding work by the Global Burden of Disease Study 2021 collaborators. Funding This work was supported by the National Natural Science Foundation of China [grant number 72304122]. Conflict of Interest Statement The authors declare no conflict of interest. Ethics approval For the use of deidentified data in GBD study, a waiver of informed consent was approved by the University of Washington Institutional Review Board. Data availability statement The data used for analyses are publicly available at https://vizhub.healthdata.org/gbd-results/. Abstract Introduction: Falls represent a significant global public health challenge. This study aims to comprehensively assess the burden of falls among individuals aged 55 years and older and analyze its temporal trends from 1990 to 2021. Methods: In this analysis based on the Global Burden of Disease Study 2021, we reported the cases and rates of incidence, prevalence, deaths and disability-adjusted life years (DALYs) related to falls among individuals aged 55 years and older from 1990 to 2021, stratified by gender, age and Sociodemographic Index (SDI) quintiles. Results: From 1990 to 2021, the falls-related incidence, prevalence, deaths and DALYs among individuals aged 55 years and older demonstrated an upward trend globally. However, a downward trend in the prevalence and DALYs related to falls was observed between 2001 to 2011. Sex-specific analyses revealed that the relevant indicators related to falls showed an upward trend among females, while the falls-related prevalence and DALYs showed a downward trend among males. Individuals aged 80 years and older showed a disproportionately higher burden of falls compared to younger age subgroups. The falls-related incidence exhibited a significant increasing trend across different SDI countries. Regionally, although the falls-related incidence showed an increasing trend in most regions from 1990 to 2021, there were some regions with a decreasing trend. Conclusions: The burden of falls among individuals aged 55 years and older remains a critical public health challenge. These findings underscore the necessity of incorporating gender- and age-specific risk profiles into the design of targeted prevention and intervention strategies. Highlights: Individuals aged 55 years and older experiences a significant burden of falls. The falls-related incidence and DALYs exhibited an upward trend from 1990 to 2021. Developing targeted interventions for individuals aged 55-60 years is imperative. Keywords: Falls; Middle-aged and elderly individuals; Disease burden; Trends Introduction Falls are a significant global public health problem. An estimated 684,000 individuals die from falls each year, making it the second leading cause of unintentional injury deaths worldwide [1] . Despite the absence of fatality, approximately 37.3 million falls are serious enough to require medical attention each year. Falls are responsible for over 38 million disability-adjusted life years (DALYs) lost each year, resulting in more years of disability than traffic injuries, drownings, burns and poisonings combined [1] . Age is one of the key risk factors for falls, and the risk of falls increases significantly with age [2] . With the intensification of aging populations, the proportion of individuals aged 55 years and older is continuously increasing globally, and their health issues are increasingly drawing attention. Notably, the prevalence of osteoarthritis in this age group gradually increases, about 73% of people living with osteoarthritis are older than 55 years [3] . Pain, muscle weakness and impaired proprioception of joints caused by osteoarthritis all increase the risk of falls [4] . Meanwhile, individuals aged 55 years and older also face a higher risk of developing sarcopenia [5] . Due to the loss of muscle mass and function, individuals with sarcopenia exhibit a correspondingly increased risk of falls [6] . Furthermore, research shows that the risk of falls is associated with multiple factors, such as health conditions, nutritional status, multidimensional balance, cognitive function, and gait speed [7-10] . These factors may all decline to varying degrees in individuals aged 55 years and older, further increasing the risk of falls [2] . Therefore, understanding the burden of falls among adults aged 55 years and older is of great significance for optimizing the allocation of public health resources and enhancing the effectiveness of prevention measures. This study aims to elucidate the global, regional and national burden of falls among middle-aged and elderly individuals. Using the Global Burden of Disease (GBD) dataset, the study analyzes trends in the incidence, prevalence, deaths and DALYs related to falls in adults aged 55 years and older from 1990 to 2021 to provide reference for the prevention and treatment of falls. Methods 2.1 Data source Global Burden of Disease (GBD) 2021 includes 371 diseases, injuries and impairments, as well as 88 risk factors, covering 204 countries and territories from 1990 to 2021. GBD 2021 estimates the impact of diseases, injuries and risk factors on health by age, sex and region, and is available directly for download [11] . This study focused on four principal metrics: incidence, prevalence, deaths and DALYs associated with falls. The study population included middle-aged and elderly individuals aged 55 years and older from the public database of the GBD 2021 (https://vizhub.healthdata.org/gbd-results/) [12] . The data for both sexes were divided into 6 age subgroups (55-59, 60-64, 65-69, 70-74, 75-79 and 80+). The Sociodemographic Index (SDI) reflects the socio-economic status of a region or country, which is based on a comprehensive assessment of per capita income, educational attainment and fertility rates [11] . The SDI categorizes regions into 5 levels: low SDI, low-middle SDI, middle SDI, high-middle SDI and high SDI. The corresponding codes of the 10 th edition of the International Classification of Disease (ICD-10) are W00 to W19 [13] . 2.2 Ethical considerations For the use of deidentified data in GBD study, a waiver of informed consent was approved by the University of Washington Institutional Review Board. 2.3 Statistical Analysis This study used annual percentage change (APC) and average annual percentage change (AAPC) to describe trends in the incidence, prevalence, deaths and DALYs due to falls over time. A linear regression model was used to calculate the AAPC and 95% confidence intervals, with the rates as the dependent variable on a logarithmic scale and each year as the independent variable. A joinpoint regression model was used to identify significant changes in data trends over time. Stratified analysis was used to determine global trends across gender, age and SDI subgroups. Regional and national trends in falls-related incidence, prevalence, deaths and DALYs were also explored using the methods just described. Statistical analyses were performed using R version 4.4.1. P < 0.05 on both sides, the difference was statistically significant. Results 3.1 Global burden of falls Globally, the incidence and deaths due to falls in the middle-aged and elderly adults increased from 1990 to 2021 (Table 1). The falls-related DALYs among middle-aged and elderly individuals increased from 1990 to 2000 (AAPC, 0.31; 95%CI, 0.26 to 0.36). However, during 2001 to 2011, the DALYs had a downward trend (AAPC, -0.37; 95%CI, -0.42 to -0.31). Then, the DALYs continued to increase from 2012 to 2021 (AAPC, 0.14; 95%CI, 0.09 to 0.19). Overall, an upward trend was observed in the DALYs related to falls from 1990 to 2021(AAPC, 0.06; 95%CI, 0.01 to 0.12; Table 1). The falls-related prevalence in the middle-aged and elderly individuals exhibited similar trends (Table 1). During the period 1990 to 2021, a joinpoint was present in the incidence from falls for middle-aged and elderly individuals in 1995, 2000, 2005, 2011 and 2019. Joinpoint regression identified three, five and three significant inflection points in the temporal trends of falls-related prevalence, deaths and DALYs, respectively (shown in Fig.1). 3.2 Global burden of falls stratified by gender From 1990 to 2021, the incidence and deaths due to falls increased globally for both females and males (Table 2, Supplementary Tables 1-2). Specifically, males had a greater increase (AAPC, 0.76; 95%CI, 0.69 to 0.84) in the incidence from falls than females (AAPC, 0.48; 95%CI, 0.45 to 0.51). However, females had a greater increase (AAPC, 0.56; 95%CI, 0.28 to 0.83) in the deaths from falls than males (AAPC, 0.44; 95%CI, 0.22 to 0.67). From 1990 to 2021, the falls-related DALYs increased among females (AAPC, 0.14; 95%CI, 0.07 to 0.21), while decreased among males (AAPC, -0.03; 95%CI, -0.08 to 0.02; Table 2, Supplementary Table 2). The falls-related prevalence exhibited similar trends (Table 2, Supplementary Table 1). In the joinpoint regression model, the incidence due to falls increased mostly in the period 1995 to 2000 in both females (APC, 1.28; 95%CI, 1.17 to 1.38) and males (APC, 1.69; 95%CI, 1.42 to 1.96; Supplementary Figure 1). 3.3 Global burden of falls stratified by age During 1990 to 2021, the falls-related incidence among middle-aged and elderly individuals aged 55 to 80+ years showed the most pronounced increase in elderly older than 80 years (AAPC, 0.62; 95%CI, 0.54 to 0.69; Table 2, Supplementary Table 1). The largest decrease in the DALYs related to falls was experienced in adults aged 55-59 years (AAPC, -0.5; 95%CI, -0.56 to -0.44), and the largest increase in the DALYs related to falls was experienced in elderly older than 80 years (AAPC, 0.26; 95%CI, 0.13 to 0.39; Table 2, Supplementary Table 2). The falls-related deaths exhibited similar trends (Table 2, Supplementary Table 2). Additionally, among elderly older than 80 years, the incidence from falls increased mostly in the period 1995 to 2000 (APC, 1.42; 95%CI, 1.12 to 1.72), then the incidence showed a decreasing trend from 2000 to 2005, and finally, a dramatic upward trend was detected in the incidence since 2005 (Supplementary Figure 2). 3.4 Global burden of falls stratified by SDI quintiles Overall, the incidence due to falls among the middle-aged and elderly individuals increased in different SDI countries (Table 2, Supplementary Table 1). Specifically, the largest increasing trends for the incidence related to falls were middle-SDI countries (AAPC, 1.24; 95%CI, 1.15 to 1.33), followed by low-SDI countries (AAPC, 0.82; 95%CI, 0.78 to 0.85). In high-SDI countries, the falls-related deaths and DALYs had the largest increasing trends (AAPC, 0.94; 95%CI, 0.74 to 1.15 and AAPC, 0.36; 95%CI, 0.26 to 0.45; Table 2, Supplementary Table 2). The results of the joinpoint regression analyses of the incidence, prevalence, deaths and DALYs from falls according to the SDI among the middle-aged and elderly individuals from 1990 to 2021 are shown in Supplementary Figure 3. 3.5 Regional burden of falls Regionally, the incidence due to falls showed an upward trend in most regions from 1990 to 2021 (Supplementary Table 3). The largest increase in the incidence from falls was detected in East Asia (AAPC, 1.71; 95%CI, 1.47 to 1.96), followed by high-income North America (AAPC, 1.57; 95%CI, 1.48 to 1.65). However, there was still a downward trend in some regions. The largest decrease was experienced in Central Latin America (AAPC, -0.89; 95%CI, -0.96 to -0.82), followed by Central Europe (AAPC, -0.22; 95%CI, -0.31 to -0.14) and Southern Sub-Saharan Africa (AAPC, -0.19; 95%CI, -0.26 to -0.12). At the regional level, the falls-related prevalence increased in most regions from 1990 to 2021, with the most pronounced increase in East Asia (AAPC, 1.08; 95%CI, 0.71 to 1.45; Supplementary Table 3). During 1990 to 2021, the largest increasing trend for the deaths related to falls was Australasia (AAPC, 2.54; 95%CI, 2.22 to 2.87), and the largest decreasing trend for the deaths related to falls was Central Latin America (AAPC, -1.81; 95%CI, -2.26 to -1.37; Supplementary Table 4). The largest increase from the DALYs due to falls was observed in high-income North America (AAPC, 1.27; 95%CI, 1.19 to 1.35), and the largest decline was observed in Central Latin America (AAPC, -1.57; 95%CI, -1.66 to -1.49; Supplementary Table 4). The joinpoint regression analysis of falls for the 21 regions is presented in Supplementary Table 5. 3.6 National and regional burden of falls At the national level, the falls-related incidence showed an increasing trend in most nations from 1990 to 2021, with the sharpest increase in Bhutan (AAPC, 3.41; 95%CI, 3.33 to 3.48). And the incidence due to falls increased in China from 1990 to 2021 (AAPC, 1.77; 95%CI, 1.52 to 2.03; shown in Fig.2; Supplementary Table 6). During 1990 to 2021, a decreasing trend for the DALYs due to falls was observed in most nations, with the sharpest decrease in Armenia (AAPC, -2.2; 95%CI, -2.59 to -1.81) and Hungary (AAPC, -2.17; 95%CI, -2.47 to -1.87), respectively. Contrastingly, an upward trend was observed in China (AAPC, 0.51; 95%CI, 0.34 to 0.68; Supplementary Table 7). Similar results were found for the deaths related to falls (Supplementary Table 7). Discussion This study clarified the trends and characteristics of falls-related burden among individuals aged 55 years and older from 1990 to 2021, indicating that the global burden due to falls is a major concern. Overall, the incidence, prevalence, deaths and DALYs related to falls exhibited an upward trend from 1990 to 2021, with the most pronounced acceleration observed in the incidence. Both males and females experienced substantial increases in the falls-related incidence between 1990 and 2021, while significant disparities in the falls-related DALYs occurred between males and females. The falls-related burden was higher among individuals aged 80 years and older compared to other age groups and exhibited an increasing trend over time. Furthermore, large variations in the incidence due to falls was observed across countries categorized by the SDI. This study expands our understanding of the falls-related burden on individuals aged 55 years and older, providing suggestions for formulating relevant policies and preventive measures. The reasons for the increased incidence of falls globally involve several aspects: First, the extension of life expectancy has contributed to changes in population structure. Life expectancy reached 73.3 years in 2024, with an increasing proportion of the elderly population [14] . With advancing age, the risks of frailty and chronic diseases increase [15, 16] . A report indicated that the prevalence related to frailty was approximately 11% among individuals aged 50-59 and rose to 51% in those aged 90 and older [17] . Frailty is strongly associated with adverse health outcomes, particularly falls [18] . Moreover, chronic conditions such as stroke and cirrhosis are risk factors of falls [19, 20] . Second, despite falls prevention is currently highly prioritized and many measures have been proven effective [21, 22] , the successful implementation of these strategies remains challenging [23] . A study indicated that the implementation of falls prevention faced multiple barriers [24] . Many older adults lack sufficient awareness for their own falls risks, which results in a lack of motivation to proactively adopt preventive measures [25] . Other factors related to the burden of falls may include medication use [26] , multimorbidity status [27] and a sedentary lifestyle [28] . Gender is a risk factor for falls [29] . In this study, we identified that the incidence related to falls was higher among females in 2021, while the increase rate in the falls-related incidence was more pronounced among males from 1990 to 2021. This result is consistent with the conclusions of relevant studies based on the Global Burden of Disease Study (GBD2019) [30] . The high incidence related to falls among females is associated with poorer physical function and higher prevalence of osteoporosis in this population [31] . The faster increase rate in the falls-related incidence among males may be attributed to higher levels of risk-taking behaviors and hazards within occupations [1] , both of which elevate the probability of falls. Furthermore, the increased life expectancy among males represents a significant factor [32] . Therefore, the influence of gender should be taken into account when formulating falls prevention strategies. At the same time, it is still necessary to actively advocate for gender-equitable implementation strategies in falls prevention programs. Individuals aged 80 years and older were the age group with the most prominent burden of falls. First, the expansion of the global population aged 80 years and older directly drives the rising incidence related to falls within this demographic [14] . Second, elevated fracture risk following falls and prolonged recovery periods in this age group significantly increase the burden of DALYs [33] . With ongoing demographic shifts toward an aging population, there is an urgent need to develop targeted intervention strategies to address the challenge of falls among older adults. The falls-related incidence exhibited disparities across countries with different SDI levels. Overall, all SDI groups show an increasing trend in the falls-related incidence, which is linked to increasing life expectancy [34, 35] . Notably, middle- and low-SDI countries demonstrate more pronounced growth rates of incidence compared to other SDI categories. Beyond aging-related factors, this is also associated with deficiencies in falls prevention strategies and suboptimal allocation of healthcare resources. A study identified barriers to healthcare access and systemic weaknesses in healthcare infrastructure as critical contributors in low- and middle- income regions [36] . Therefore, countries with lower SDI levels need to enhance the allocation of primary healthcare resources, optimize public health policies, and incorporate falls prevention into national health priority to reduce the burden of falls. International collaboration should be intensified to foster cross-border knowledge sharing and technological cooperation, enabling a coordinated global response to falls-related risks. Previous studies on the falls-related burden have predominantly focused on populations aged 60 years and older [37] , while the transitional age group of 55-59 years has not been adequately explored. This study is the first to extend the scope to individuals aged 55 years and older, systematically assessing falls-related incidence, prevalence, deaths and DALYs in this population. This study revealed a significant upward trend in the incidence related to falls among individuals aged 55 years and older, indicating a “younger-onset” pattern of falls risk. Moreover, current prevention strategies, which predominantly target populations aged 60 years and older [38] , fail to address the 55-59 age group, exposing a critical gap in coverage. To tackle this unmet need, this study proposes two strategies. First, we advocate advancing the falls prevention window to 55 years by establishing age-specific early screening guidelines and targeted intervention programs to halt risk accumulation. Second, we call for constructing a life-course health framework to implement proactive risk prevention strategies. There are several limitations of this study. First, the findings are constrained by variations in data quality and incompleteness within the GBD database. Although the GBD database integrates multiple data sources from diverse countries and regions to establish a global burden-of-disease estimation system, disparities in the maturity of national health information infrastructure persist. Second, in regions with missing primary data, reliance on statistical modeling to fill gaps may introduce additional uncertainty [39] . Finally, the data for populations aged 55 years and older were not age-standardized in this study. Consequently, the estimates are influenced by population age structures, which may compromise the reliability of cross-regional or interpopulation comparisons of falls-related burdens, especially in areas with significant demographic heterogeneity. Conclusions The burden of falls among individuals aged 55 years and older remains a critical public health challenge and is increasing globally, with significant disparities observed across gender, age group and SDI levels. 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Global Average Annual Percentage Changes (AAPCs) in Incidence, Prevalence, Deaths and Disability-Adjusted Life-Years (DALYs) of Falls Among Middle-aged and elderly individuals Period AAPC (95%CI) P value AAPC (95%CI) P value AAPC (95%CI) P value AAPC (95%CI) P value 1990-2000 0.78 ( 0.57-1 ) < .001 0.47 ( 0.43-0.52 ) < .001 0.42 ( 0.26-0.57 ) < .001 0.31 ( 0.26-0.36 ) < .001 2001-2011 0.2 ( 0.17-0.23 ) < .001 -0.5 ( -0.56–0.43 ) < .001 0.4 ( 0.12-0.69 ) 0.006 -0.37 ( -0.42–0.31 ) < .001 2012-2021 0.78 ( 0.7-0.85 ) < .001 0.31 ( 0.11-0.5 ) 0.003 0.33 ( 0.15-0.51 ) < .001 0.14 ( 0.09-0.19 ) < .001 1990-2021 0.57 ( 0.54-0.61 ) < .001 0.05 ( -0.04-0.13 ) 0.286 0.47 ( 0.14-0.8 ) 0.006 0.06 ( 0.01-0.12 ) 0.029 Table 2. The Average Annual Percentage Changes (AAPCs) in Incidence, Prevalence, Deaths and Disability-Adjusted Life-Years (DALYs) of Falls From 1990 to 2021 Among middle-aged and elderly individuals at the Global Level, Stratified by Sex, Age and Sociodemographic Index (SDI) Characteristic AAPC,1990-2021(95%CI) P Value AAPC,1990-2021(95%CI) P Value AAPC,1990-2021,(95%CI) P Value AAPC,1990-2021,(95%CI) P value Global 0.57 ( 0.54-0.61 ) < .001 0.05 ( -0.04-0.13 ) 0.286 0.47 ( 0.14-0.8 ) 0.006 0.06 ( 0.01-0.12 ) 0.029 Sex Female 0.48 ( 0.45-0.51 ) < .001 0.14 ( 0.05-0.23 ) 0.002 0.56 ( 0.28-0.83 ) < .001 0.14 ( 0.07-0.21 ) < .001 Male 0.76 ( 0.69-0.84 ) < .001 -0.08 ( -0.14–0.03 ) 0.004 0.44 ( 0.22-0.67 ) < .001 -0.03 ( -0.08-0.02 ) 0.19 Age group 55-59 years 0.18 ( 0.12-0.24 ) < .001 -0.38 ( -0.48–0.28 ) < .001 -0.55 ( -0.75–0.34 ) < .001 -0.5 ( -0.56–0.44 ) < .001 60-64 years 0.41 ( 0.36-0.46 ) < .001 -0.31 ( -0.41–0.21 ) < .001 -0.4 ( -0.67–0.13 ) 0.004 -0.37 ( -0.49–0.25 ) < .001 65-69 years 0.4 ( 0.35-0.45 ) < .001 -0.16 ( -0.22–0.1 ) < .001 -0.18 ( -0.54-0.19 ) 0.343 -0.2 ( -0.34–0.06 ) 0.006 70-74 years 0.38 ( 0.3-0.46 ) < .001 0.11 ( 0.03-0.18 ) 0.005 -0.06 ( -0.31-0.2 ) 0.649 -0.02 ( -0.18-0.13 ) 0.759 75-79 years 0.3 ( 0.22-0.38 ) < .001 -0.04 ( -0.11-0.02 ) 0.174 0.14 ( -0.12-0.4 ) 0.294 0.03 ( -0.12-0.18 ) 0.675 80+ years 0.62 ( 0.54-0.69 ) < .001 0.27 ( 0.21-0.33 ) < .001 0.48 ( 0.2-0.76 ) 0.001 0.26 ( 0.13-0.39 ) < .001 SDI High-middle SDI 0.4 ( 0.31-0.49 ) < .001 -0.2 ( -0.32–0.07 ) 0.002 0.54 ( 0.15-0.94 ) 0.006 -0.2 ( -0.36–0.05 ) 0.01 High SDI 0.74 ( 0.7-0.78 ) < .001 0.23 ( 0.2-0.27 ) < .001 0.94 ( 0.74-1.15 ) < .001 0.36 ( 0.26-0.45 ) < .001 Low-middle SDI 0.42 ( 0.39-0.45 ) < .001 0.13 ( 0.1-0.17 ) < .001 0.3 ( -0.21-0.81 ) 0.247 0.01 ( -0.24-0.26 ) 0.929 Low SDI 0.82 ( 0.78-0.85 ) < .001 0.42 ( 0.4-0.44 ) < .001 0.09 ( -0.23-0.42 ) 0.573 0.03 ( -0.19-0.24 ) 0.815 Middle SDI 1.24 ( 1.15-1.33 ) < .001 0.62 ( 0.49-0.74 ) < .001 0.27 ( 0.1-0.44 ) 0.001 0.15 ( 0.06-0.24 ) 0.001 Figure legends Fig.1 Joinpoint Regression Analysis of Global Falls Burden Among middle-aged and elderly individuals from 1990 to 2021 ( a , Incidence; b , Prevalence; c , Deaths; d , DALYs; APC, annual percentage change; DALYs, disability-adjusted life years) Fig.2 Map of National Average Annual Percentage Changes (AAPCs) in Falls Burden Among middle-aged and elderly individuals from 1990 to 2021 ( a , Incidence; b , Prevalence; c , Deaths; d , DALYs; DALYs, disability-adjusted life years) Supplementary Material File (figures.docx) Download 9.36 MB Information & Authors Information Version history V1 Version 1 21 November 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords disease burden falls middle-aged and elderly individuals trends Authors Affiliations Ziyue Zhou Qingdao University Qingdao Medical College View all articles by this author Jingwei Zhou The Affiliated Hospital of Qingdao University View all articles by this author Jingjing Li Qingdao University Qingdao Medical College View all articles by this author Zihan Xue Qingdao University Qingdao Medical College View all articles by this author Tao Wang University of Health and Rehabilitation Sciences View all articles by this author Yunping Zhou 0000-0001-6132-7590 [email protected] Qingdao University Qingdao Medical College View all articles by this author Metrics & Citations Metrics Article Usage 321 views 113 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ziyue Zhou, Jingwei Zhou, Jingjing Li, et al. 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