Fall-related incidence and disability burden among older adults after COVID-19 onset: A Global Burden of Disease 2023 counterfactual analysis.

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.