Trends and Disparities in Fall-Related Head Injury Mortality Among Middle-Aged and Older Adults (>55 Years) in the United States: A 21-Year National Analysis (1999-2020).

BACKGROUND

Head injury is a leading cause of mortality from falls in adults aged ≥55 years. This study assessed demographic and geographic disparities in fall-related head injury mortality among United States adults from 1999 to 2020.

METHODS

Mortality data were extracted from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database using International Classification of Diseases (ICD-10) codes for falls (W00-W19) and head injuries (S00-S09). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated by year, sex, race/ethnicity, state, and urban-rural status. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC). We refer to our cohort as "middle-aged and older adults (≥55 years)" on the basis of epidemiological and trauma literature identifying midlife as the stage when fall risk and adverse head injury outcomes begin to rise. Furthermore, the World Society of Emergency Surgery (WSES) 2023 trauma guidelines explicitly recognize patients aged ≥55 years as a high-risk population requiring special consideration, reinforcing the clinical relevance of this cutoff.

RESULTS

Between 1999 and 2020, 252,750 fall-related head injury deaths occurred among adults aged ≥55 years. Most deaths occurred in medical settings (69.6%), followed by homes (9.2%), long-term care (8.8%), and hospices (8.7%). AAMR nearly doubled, from 9.71 to 19.85, with a steeper rise from 1999 to 2007 (APC: 6.53) and slower growth thereafter (APC: 1.92). AAMRs were higher in men (22.1) than women (11.8), and highest in adults ≥85 years (81.7). Non-Hispanic (NH) Whites had the highest AAMR (16.8), followed by NH Asians/Pacific Islanders (15.8), Hispanics (12.6), and NH Blacks (8.6). In 2020, state-level AAMRs ranged from 9.5 (Alabama) to 24.0 (Wisconsin), with rural areas slightly exceeding urban ones (20.3 vs. 19.8).

CONCLUSION

Fall-related head injury mortality in US adults aged ≥55 years has steadily increased. Tailored prevention strategies are critical to reducing these preventable deaths, particularly in high-risk groups.