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© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.047779
RESEARCH AND PRACTICE |
Pekka Kannus, Seppo Niemi, and Mika Palvanen are with the Accident & Trauma Research Center, President Urho Kaleva Kekkonen Institute for Health Promotion Research, Tampere, Finland. Pekka Kannus is also with the Department of Surgery, Tampere University Medical School and University Hospital, Tampere, Finland. Jari Parkkari is with Tampere Research Center of Sports Medicine, President Urho Kaleva Kekkonen Institute for Health Promotion Research.
Correspondence: Requests for reprints should be sent to Pekka Kannus, MD, PhD, UKK Institute, PO Box 30, FIN-33501 Tampere, Finland (e-mail: pekka.kannus{at}uta.fi).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Falls and fall-induced injuries in older people are a major public health problem in modern societies with aging populations. Injury is the fifth leading cause of death in older adults, and most of these fatal injuries are related to falls.
We have assessed the nationwide trends in fall-induced deaths of older people in Finland for more than 3 decades (1971–2002), and the results showed that the number of fall-induced deaths among elderly Finns is clearly increasing, especially among men.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Falls and fall-induced injuries in older people are a major public health problem in modern societies with aging populations.1–3 Injury, in turn, is the fifth leading cause of death in older adults, and most of these fatal injuries are related to falls.2–5 The purpose of this study was to assess recent nationwide trends in fall-induced deaths of older people in Finland, a European country with a well-defined White population of 5.2 million inhabitants, from 1971 to 2002.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We obtained the study data from the Finnish Official Cause-of-Death Statistics for adults aged 50 years or older who died from a fall-induced injury between 1971 and 2002. This statutory register has been computer-based since 1971, and it has been updated and quality controlled by the Cause-of-Death Bureau at Statistics Finland since its inception.4 The main categories of death from unintentional injury are road traffic injuries (394 death cases in Finland in 2002), water traffic injuries (69 deaths), falls (1122 deaths), drownings (163 deaths), and poisonings (186 deaths).4,6 For deaths from intentional injury, the main categories are suicides (1095 deaths) and homicides (133 deaths).
The Finnish Official Cause-of-Death Statistics are, in practice, 100% complete because each death, its official certificate (issued by the physician who certified the death), and the corresponding person information in our computerized population register are cross-checked. The accuracy of the data is, in turn, maximized by triple-checking each code of the death certificate.4,6 In injury-based deaths, the accuracy of the Finnish death certificates and their cause-of-death codes is verified further by autopsies performed in 94% to 97% of these deaths.4,6
The mortality data were drawn from the entire population of adults aged 50 years or older in Finland, which was 1 154 968 in 1971 and 1 826 356 in 2002. Thus, the absolute numbers and incidences of deaths were not sample-based estimates but true descriptions of the whole population. To calculate the age-adjusted incidences, the age adjustment was done by means of direct standardization using the mean population of persons aged 50 years or older between 1971 and 2002 as the standard population or reference point. In this way, the population and its death rates became comparable across the study years and allowed annual assessment of the average individual risk for fall-induced death. The age-specific incidence rates were calculated in the age groups of 50 to 59, 60 to 69, 70 to 79, and 80 years or older.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The number of fall-induced deaths in older Finns increased considerably between the years 1971 and 2002: from 441 to 1039 overall (a 136% increase), from 162 to 488 in men (a 201% increase), and from 279 to 551 in women (a 97% increase). In men, the age-adjusted incidence of fall-induced deaths also increased during the study period—41.8 (per 100 000 persons) in 1971 and 55.4 in 2002 (Figure 1a
). The finding was similar in age-specific incidence rates: in 1971 to 1975, the mean incidence rates were 12.6, 21.8, 64.9, and 268.7 in the age groups of 50 to 59, 60 to 69, 70 to 79, and 80 years or older, respectively, compared with 25.4, 36.0, 83.9, and 377.6 in 1998 to 2002. Figure 1a shows that the age-adjusted incidence of fall-induced deaths decreased among women between 1971 and 1975, after which it has stayed relatively stable (43.1 in 2002). A similar finding was observed in women’s age-specific incidence rates. Since 1986, the age-adjusted incidence of fall-induced deaths has always been higher in men than in women (Figure 1a).
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If we assume that the observed relatively linear development in the fall-induced death rate of men will continue, that of women will remain stable (i.e., at the current level), and the size of the population of older Finns will increase as predicted,7 then the annual number of 50-year-old or older Finns experiencing a fall-induced death would be estimated to increase steeply during the coming 3 decades, from 1039 in the year 2002 to about 2170 in the year 2030 (a 108% increase; Figure 1b
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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This study showed that the number of fall-induced deaths of Finns aged 50 years or older more than doubled between 1971 and 2002 and that in men, the age-adjusted and age-specific incidence rates (i.e., the average individual risk) of such deaths also rose. We believe that the more than 1000 annual fall-induced deaths among Finnish older adults already are a serious concern, but even worse is that the predicted aging of the Finnish population is likely to accentuate the burden so that by the year 2030, Finland and its 5 million inhabitants may face more than 2000 similar deaths each year. Most likely, similar increases also will occur in many other Western populations.
Our data corroborate previous observations on the development of various fall-related injuries in elderly people1,2,4,8 but cannot specify the exact reasons for the increase in the age-adjusted incidence of fall-induced deaths in men. An increase in the average risk of falling may partly explain the phenomenon, or elderly men now may have more serious consequences of falling than did their predecessors.2,4 In other words, on average, elderly men who fall now may be less healthy and functionally less capable than their age-matched counterparts in the past so that not even improved trauma care has been able to stop this regrettable increase in fall-induced deaths.
In conclusion, the number of fall-induced deaths among elderly Finns shows a clear increase. In men, the increase has occurred at a rate that cannot be explained merely by demographic changes. Therefore, detailed epidemiological studies, in addition to investigations of possible behavioral, environmental, and biological predisposing factors and dynamics, are needed to better understand this phenomenon. In addition, in both women and men, multifield, broad-scale fall-prevention interventions should be urgently implemented to control the problem.
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Acknowledgments |
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This study was supported by the Medical Research Fund of Tampere University Hospital, Tampere, Finland (grant 9E025).
Human Participant Protection
No protocol approval was needed for this study.
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Footnotes |
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Peer Reviewed
Contributors
All authors were involved in the study design, data acquisition and analysis, and writing of the brief.
Accepted for publication June 24, 2004.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet. 1999;353:802–805.[CrossRef][Web of Science][Medline]
2. Kannus P, Niemi S, Palvanen M, Parkkari J. Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons. Arch Intern Med. 2000;160:2145–2149.
3. Tinetti ME. Preventing falls in elderly persons. N Engl J Med. 2003;348:42–49.
4. Kannus P, Parkkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA. 1999;281:1895–1899.
5. Rivara FP, Grossman DC, Cummings P. Injury prevention. N Engl J Med. 1997;337:543–547.
6. Official Statistics of Finland. Official Cause-of-Death Statistics 2002. Helsinki: Statistics Finland; 2003.
7. Official Statistics of Finland. Population Projections 2001–2030. Helsinki: Statistics Finland; 2001.
8. Shinoda-Tagawa T, Clark DE. Trends in hospitalization after injury: older women are displacing young men. Inj Prev. 2003;9:214–219.
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