Archives of gerontology and geriatrics · 2026
Fall-related incidence and disability burden among older adults after COVID-19 onset: A Global Burden of Disease 2023 counterfactual analysis.
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Lian Rongna, Pu Hongshan, Jiang Wenhua, Gao Ya, He Tianwen, Zhang Wenyi, Luo Shuyue, Chen Qian, Yang Ming
Аннотация
OBJECTIVES: To examine whether fall-related incidence and modelled disability burden among adults 60 years or older differed from pre-2020 expectations after COVID-19 onset, while accounting for uncertainty in Global Burden of Disease (GBD) estimates.
METHODS: We used GBD 2023 falls estimates for adults 60 years or older. Autoregressive integrated moving average (ARIMA) models fitted to 1990-2019 data estimated expected 2020-2023 rates for incidence, deaths, years lived with disability (YLDs), years of life lost, disability-adjusted life-years (DALYs), and the YLD-to-incidence ratio (YIR; YLD rate divided by incidence rate). The primary contrast compared pre-2020 model-derived expectations with post-2020 modelled GBD estimates. GBD-uncertainty stress tests were conducted under independence assumptions; policy, inequality, risk-attribution, projection, and decomposition analyses provided contextual evidence.
RESULTS: Incidence remained close to expected trajectories in 2020 (deviation 0.22%, forecast-deviation interval -0.34 to 0.79) and 2023 (1.32%, -2.49 to 5.44). By 2023, ARIMA point estimates suggested DALY rates 11.4% above expected; the secondary YIR showed a similar point-estimate increase of 16.6%. GBD-uncertainty stress-test intervals crossed the no-deviation threshold for both DALYs (-21.6% to 32.3%) and YIR (-40.7% to 34.2%). Alternative models yielded 2023 DALY point deviations from 5.8% to 16.5%, showing sensitivity to counterfactual specification.
CONCLUSION: In GBD 2023 modelled estimates, fall incidence remained close to expected trajectories, whereas disability-burden point estimates were higher by 2023. This point-estimate contrast supports population-level post-fall recovery surveillance and service planning, while interpretation should account for wide GBD uncertainty.
METHODS: We used GBD 2023 falls estimates for adults 60 years or older. Autoregressive integrated moving average (ARIMA) models fitted to 1990-2019 data estimated expected 2020-2023 rates for incidence, deaths, years lived with disability (YLDs), years of life lost, disability-adjusted life-years (DALYs), and the YLD-to-incidence ratio (YIR; YLD rate divided by incidence rate). The primary contrast compared pre-2020 model-derived expectations with post-2020 modelled GBD estimates. GBD-uncertainty stress tests were conducted under independence assumptions; policy, inequality, risk-attribution, projection, and decomposition analyses provided contextual evidence.
RESULTS: Incidence remained close to expected trajectories in 2020 (deviation 0.22%, forecast-deviation interval -0.34 to 0.79) and 2023 (1.32%, -2.49 to 5.44). By 2023, ARIMA point estimates suggested DALY rates 11.4% above expected; the secondary YIR showed a similar point-estimate increase of 16.6%. GBD-uncertainty stress-test intervals crossed the no-deviation threshold for both DALYs (-21.6% to 32.3%) and YIR (-40.7% to 34.2%). Alternative models yielded 2023 DALY point deviations from 5.8% to 16.5%, showing sensitivity to counterfactual specification.
CONCLUSION: In GBD 2023 modelled estimates, fall incidence remained close to expected trajectories, whereas disability-burden point estimates were higher by 2023. This point-estimate contrast supports population-level post-fall recovery surveillance and service planning, while interpretation should account for wide GBD uncertainty.