摘要：Objectives. We determined time trends in numbers and rates of fall-related mortality in an aging population, for men and women. Methods. We performed secular trend analysis of fall-related deaths in the older Dutch population (persons aged 65 years or older) from 1969 to 2008, using the national Official-Cause-of-Death-Statistics. Results. Between 1969 and 2008, the age-adjusted fall-related mortality rate decreased from 202.1 to 66.7 per 100 000 older persons (decrease of 67%). However, the annual percentage change (change per year) in mortality rates was not constant, and could be divided into 3 phases: (1) a rapid decrease until the mid-1980s (men −4.1%; 95% confidence interval [CI] = −4.9, −3.2; women −6.5%; 95% CI, −7.1, −5.9), (2) flattening of the decrease until the mid-1990s (men −1.4%; 95% CI = −2.4, −0.4; women −2.0%; 95% CI = −3.4, −0.6), and (3) stable mortality rates for women (0.0%; 95% CI = −1.2, 1.3) and rising rates for men (1.9%; 95% CI = 0.6, 3.2) over the last decade. Conclusions. The spectacular decrease in fall-related mortality ended in the mid-1990s and is currently increasing in older men at similar rates to those seen in women. Because of the aging society, absolute numbers in fall-related deaths are increasing rapidly. Unintended falls present a major public health problem worldwide. 1–3 The World Health Organization (WHO) estimated that approximately 392 000 people worldwide died because of an unintended fall in 2004. 4 According to the Centers for Disease Control and Prevention in the United States, unintended falls are the leading cause of fatal injuries among older adults. 5 Falls in older adults mainly occur in or around the home, and their cause is often multifactorial. 6 Risk factors associated with fall incidents include older age, female gender, use of medications that increase fall risk, and comorbidities. 7 Approximately one third of all community-dwelling persons aged 65 years or older fall annually, 7,8 which leads to high health care demand, morbidity, and mortality. 2,9–13 The incidence rate of falls is age- and gender-dependent. The majority of falls and related injuries occur in older women (75 years or older). 9,14,15 Furthermore, the incidence rates of fall-related injuries among older adults increased over the past 30 years. 3 New guidelines and preventive strategies were developed to reduce falls among older adults. 16 Absolute numbers of fall-related deaths are increasing because of aging societies worldwide. 17 In The Netherlands, the absolute number of persons aged 65 years or older is expected to double (up to 25% of the population) in 2040 (this percentage was 15% in 2008). 18 The figures of aging societies are comparable to worldwide trends. 19 Because of the expanding older population, based on an increasing life expectancy, an increase in absolute numbers of fall-related deaths might be expected in the near future. To investigate how fall-related mortality in persons aged 65 years or older developed over time in The Netherlands, absolute numbers of fall-related deaths and adjusted mortality rates corrected for demographic changes were quantified from 1969 to 2008. Significant health differences between both genders were demonstrated in the older population, 20 and it was known that temporal trends in disease mortality might show large gender differences as well. 21,22 Therefore, separate analyses for men and women were conducted, which were further specified by age group.
