Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20–64 years (younger adults) and 65 years and older (older adults). Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3–13·6), an increase of 65·3% (61·9–68·8) from 8·1 deaths per 100 000 (8·0–8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0–18·2]) and White population (14·8 deaths per 100 000 [14·6–15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3–9·0]), Black (8·1 deaths per 100 000 [7·9–8·4]), and Asian (7·5 deaths per 100 000 [7·1–7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all