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Falls are events that occur when an individual inadvertently lands on the ground, floor, or a lower level (1). A significant public health concern, falls cause over 684,000 deaths globally each year, making them the second leading cause of unintentional injury deaths worldwide. Falls can also result in non-fatal consequences, such as disability, functional impairment, and restricted activity, which cause a significant burden on families and societies in terms of disease and economic losses (2).
This study aims to analyze the epidemiological characteristics and influencing factors of fall injuries using data from the NISS between 2019 and 2022. The results will help identify key intervention areas and provide a scientific basis for fall prevention and control.
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Between 2019 and 2022, NISS recorded 2,324,577 falls, comprising 1,345,181 males and 982,396 females. Of these, 1,685,880 occurred in urban areas and 638,697 in rural areas (urban-rural ratio: 1∶0.38). Monitoring hospitals in the eastern region reported 1,257,024 cases (54.08%), while the central and western regions reported 16.52% and 29.40%, respectively. The average age was 36.88±24.32 years (males: 33.22±22.90 years; females: 41.87±25.28 years) (Table 1).
Age group
(years)Sex Urban-rural Geographical distribution Total, n
(%)Male, n
(%)Female, n
(%)Urban, n
(%)Rural, n
(%)Eastern, n
(%)Central, n
(%)Western, n
(%)0 6,561
(0.49)5,043
(0.51)10,015
(0.59)1,589
(0.25)7,438
(0.59)885
(0.23)3,281
(0.48)11,604
(0.50)1–9 265,678
(19.79)153,763
(15.65)308,197
(18.28)111,244
(17.42)225,830
(17.97)64,279
(16.74)129,332
(18.92)419,441
(18.04)10–19 202,591
(15.09)81,868
(8.33)200,243
(11.88)84,216
(13.19)142,459
(11.33)49,626
(12.92)92,374
(13.51)284,459
(12.24)20–29 152,608
(11.37)90,633
(9.23)197,711
(11.73)45,530
(7.13)146,116
(11.62)27,905
(7.27)69,220
(10.13)243,241
(10.46)30–39 189,703
(14.13)114,034
(11.61)236,775
(14.04)66,962
(10.48)184,314
(14.66)37,994
(9.89)81,429
(11.91)303,737
(13.07)40–49 160,800
(11.98)110,083
(11.21)195,999
(11.63)74,884
(11.72)144,811
(11.52)40,636
(10.58)85,436
(12.50)270,883
(11.65)50–59 173,654
(12.94)153,500
(15.63)225,183
(13.36)101,971
(15.97)165,868
(13.20)62,214
(16.20)99,072
(14.49)327,154
(14.07)60–69 95,952
(7.15)122,073
(12.43)145,297
(8.62)72,728
(11.39)115,143
(9.16)44,901
(11.69)57,981
(8.48)218,025
(9.38)70–79 56,803
(4.23)86,270
(8.78)93,232
(5.53)49,841
(7.80)70,764
(5.63)33,138
(8.63)39,171
(5.73)143,073
(6.15)80–102 37,831
(2.82)65,129
(6.63)73,228
(4.34)29,732
(4.66)54,281
(4.32)22,455
(5.85)26,224
(3.84)102,960
(4.43)Total 1,342,181
(100.00)982,396
(100.00)1,685,880
(100.00)638,697
(100.00)1,257,024
(100.00)384,033
(100.00)683,520
(100.00)2,324,577
(100.00)Abbreviation: NISS=National Injury Surveillance System. Table 1. Demographic characteristics of fall cases in the NISS of China, 2019–2022.
Falls occurred mainly during the daytime (06:00–17:59, 67.37%). The most common locations for falls were at home (39.41%), on the road/street (17.62%), and in public residential institutions (15.66%). Fall locations varied by age group. Falls in school and school-related areas were highest among individuals aged 10–19 years, followed by those at home. Leisure activities accounted for most falls (39.40%) but differed by age. Sports activities caused most falls (27.37%) among individuals aged 10–19 years, while falls at work were most common (22.87%) among those aged 40–49 years (Table 2).
Characteristics Sex* Age (years)* Total,
n (%)Male,
n (%)Female,
n (%)0,
n (%)1–9,
n (%)10–19,
n (%)20–29,
n (%)30–39,
n (%)40–49,
n (%)50–59,
n (%)60–69,
n (%)70–79,
n (%)80–102,
n (%)Time 00:00–05:59 142,443
(10.61)97,619
(9.94)1,370
(11.81)31,195
(7.44)26,071
(9.17)35,609
(14.64)38,710
(12.74)29,909
(11.04)32,393
(9.90)20,191
(9.26)13,597
(9.50)11,017
(10.70)240,062
(10.33)06:00–11:59 435,416
(32.44)350,971
(35.73)3,051
(26.29)106,624
(25.42)78,219
(27.50)71,138
(29.25)101,685
(33.48)100,928
(37.26)130,410
(39.86)91,712
(42.06)61,138
(42.73)41,482
(40.29)786,387
(33.83)12:00–17:59 457,843
(34.11)321,823
(32.76)3,659
(31.53)148,036
(35.29)109,466
(38.48)77,043
(31.67)95,839
(31.55)88,123
(32.53)107,784
(32.95)70,242
(32.22)46,075
(32.20)33,399
(32.44)779,666
(33.54)18:00–23:59 306,479
(22.83)211,983
(21.58)3,524
(30.37)133,586
(31.85)70,703
(24.86)59,451
(24.44)67,503
(22.22)51,923
(19.17)56,567
(17.29)35,880
(16.46)22,263
(15.56)17,062
(16.57)518,462
(22.30)Site Home 467,913
(34.86)448,282
(45.63)9,364
(80.70)235,072
(56.04)56,326
(19.80)58,871
(24.20)85,095
(28.02)80,851
(29.85)118,635
(36.26)106,222
(48.72)89,512
(62.56)76,247
(74.05)916,195
(39.41)Public residential institution 212,005
(15.80)151,982
(15.47)1,585
(13.66)73,497
(17.52)39,610
(13.92)44,890
(18.45)52,660
(17.34)42,716
(15.77)48,227
(14.74)31,244
(14.33)18,445
(12.89)11,113
(10.79)363,987
(15.66)School and school-related areas 151,946
(11.32)79,259
(8.07)219
(1.89)60,124
(14.33)105,579
(37.12)20,088
(8.26)13,050
(4.30)10,089
(3.72)10,537
(3.22)6,410
(2.94)3,282
(2.29)1,827
(1.77)231,205
(9.95)Sports and athletics area 75,549
(5.63)29,674
(3.02)56
(0.48)13,555
(3.23)37,064
(13.03)19,213
(7.90)15,042
(4.95)8,014
(2.96)6,325
(1.93)3,781
(1.73)1,562
(1.09)611
(0.59)105,223
(4.53)Road/street 231,428
(17.24)178,227
(18.14)267
(2.30)28,909
(6.89)38,453
(13.52)61,827
(25.42)74,642
(24.57)61,539
(22.72)68,456
(20.92)44,012
(20.19)21,215
(14.83)10,335
(10.04)409,655
(17.62)Commercial and serve area 45,517
(3.39)45,521
(4.63)69
(0.59)5,276
(1.26)3,865
(1.36)16,893
(6.94)22,260
(7.33)18,272
(6.75)15,583
(4.76)5,376
(2.47)2,382
(1.66)1,062
(1.03)91,038
(3.92)Industrial and construction area 119,875
(8.93)20,528
(2.09)10
(0.09)329
(0.08)1,375
(0.48)17,738
(7.29)34,642
(11.41)38,465
(14.20)39,959
(12.21)6,729
(3.09)886
(0.62)270
(0.26)140,403
(6.04)Farm/farmland 27,851
(2.08)21,771
(2.22)7
(0.06)435
(0.10)468
(0.16)1,454
(0.60)3,787
(1.25)8,597
(3.17)16,757
(5.12)12,532
(5.75)4,779
(3.34)806
(0.78)49,622
(2.13)Others 1,752
(0.13)1,277
(0.13)8
(0.07)429
(0.10)189
(0.07)345
(0.14)378
(0.12)394
(0.15)529
(0.16)407
(0.19)234
(0.16)116
(0.11)3,029
(0.13)Unknown 8,345
(0.62)5,875
(0.60)19
(0.16)1,815
(0.43)1,530
(0.54)1,922
(0.79)2,181
(0.72)1,946
(0.72)2,146
(0.66)1,312
(0.60)776
(0.54)573
(0.56)14,220
(0.61)Activity Work 173,419
(12.92)65,097
(6.63)0
(0.00)33
(0.01)2,271
(0.80)32,729
(13.46)57,898
(19.06)61,957
(22.87)64,373
(19.68)15,566
(7.14)3,101
(2.17)588
(0.57)238,516
(10.26)Housework 118,253
(8.81)152,710
(15.54)106
(0.91)6,245
(1.49)8,011
(2.82)18,457
(7.59)32,707
(10.77)38,802
(14.32)62,899
(19.23)53,291
(24.44)34,068
(23.81)16,377
(15.91)270,963
(11.66)Education activities 20,179
(1.50)9,736
(0.99)15
(0.13)8,203
(1.96)16,122
(5.67)1,866
(0.77)990
(0.33)916
(0.34)990
(0.30)430
(0.20)241
(0.17)142
(0.14)29,915
(1.29)Sports activities 122,582
(9.13)48,978
(4.99)87
(0.75)26,715
(6.37)77,846
(27.37)24,366
(10.02)17,153
(5.65)9,274
(3.42)7,688
(2.35)4,923
(2.26)2,266
(1.58)1,242
(1.21)171,560
(7.38)Leisure activities 528,982
(39.41)386,953
(39.39)6,334
(54.58)262,462
(62.57)112,378
(39.51)92,725
(38.12)105,902
(34.87)81,468
(30.07)95,224
(29.11)72,802
(33.39)48,652
(34.01)37,988
(36.90)915,935
(39.40)Life activity 123,163
(9.18)102,232
(10.41)4,310
(37.14)56,831
(13.55)20,251
(7.12)17,478
(7.19)21,898
(7.21)19,457
(7.18)24,981
(7.64)20,675
(9.48)19,481
(13.62)20,033
(19.46)225,395
(9.70)Driving/riding vehicles 59,095
(4.40)41,921
(4.27)53
(0.46)4,257
(1.01)9,874
(3.47)16,494
(6.78)19,161
(6.31)17,186
(6.34)19,053
(5.82)10,476
(4.80)3,562
(2.49)900
(0.87)101,016
(4.35)Walking 170,647
(12.71)156,769
(15.96)402
(3.46)42,593
(10.15)32,841
(11.55)35,706
(14.68)43,664
(14.38)37,608
(13.88)46,180
(14.12)35,643
(16.35)29,162
(20.38)23,617
(22.94)327,416
(14.08)Others 6,948
(0.52)4,682
(0.48)54
(0.47)5,570
(1.33)1,436
(0.50)443
(0.18)598
(0.20)629
(0.23)949
(0.29)874
(0.40)643
(0.45)434
(0.42)11,630
(0.50)Unknown 18,913
(1.41)13,318
(1.36)243
(2.09)6,532
(1.56)3,429
(1.21)2,977
(1.22)3,766
(1.24)3,586
(1.32)4,817
(1.47)3,345
(1.53)1,897
(1.33)1,639
(1.59)32,231
(1.39)Total 1,342,181
(100.00)982,396
(100.00)11,604
(100.00)419,441
(100.00)284,459
(100.00)243,241
(100.00)303,737
(100.00)270,883
(100.00)327,154
(100.00)218,025
(100.00)143,073
(100.00)102,960
(100.00)2,324,577
(100.00)Abbreviation: NISS=National Injury Surveillance System.
* Differences in characteristics between genders and age groups were all statistically significant, all P<0.001.Table 2. Characteristics of time, sites, and activity for all fall cases in the NISS of China, 2019–2022.
For individuals aged 0–39 years, bruises (50.08%), sprains (21.16%), and fractures (12.93%) were the 3 most common fall-related injuries. Among those aged 40–69 years, the 3 most common injuries were bruises (40.90%), fractures (27.07%), and sprains (19.21%), while fractures (40.73%) were most common among those aged 70 years and older. Females (23.26%) had a higher proportion of fractures than males (19.07%). Lower limb injuries (31.57%) were the most common, followed by head (26.34%), upper limb (21.30%), and torso (14.31%) injuries, accounting for 93.52% of all cases. The injured body parts varied by age group. Infants aged 0 years most frequently experienced head injuries (72.64%). Among those aged 60 years and older, the proportion of head injuries increased with age. Most fall cases were mild in severity (73.41%), with moderate and severe cases accounting for 24.69% and 1.90%, respectively. Severe cases increased with age. Most cases were discharged after treatment (83.85%), followed by hospitalization (13.23%) and observation (1.78%). The proportion of hospitalizations increased with age (Table 3).
Characteristics Sex* Age (years)* Total,
n (%)Male,
n (%)Female,
n (%)0,
n (%)1–9,
n (%)10–19,
n (%)20–29,
n (%)30–39,
n (%)40–49,
n (%)50–59,
n (%)60–69,
n (%)70–79,
n (%)80–102,
n (%)Nature of injury Fracture 255,945
(19.07)228,458
(23.26)713
(6.14)41,962
(10.00)40,836
(14.36)29,580
(12.16)50,156
(16.51)59,437
(21.94)90,761
(27.74)70,738
(32.44)54,872
(38.35)45,348
(44.04)484,403
(20.84)Sprain 247,335
(18.43)203,430
(20.71)1,186
(10.22)52,975
(12.63)76,272
(26.81)63,138
(25.96)73,590
(24.23)57,708
(21.30)62,524
(19.11)36,602
(16.79)18,388
(12.85)8,382
(8.14)450,765
(19.39)Sharps injury, bites and open wounds 156,441
(11.66)84,049
(8.56)931
(8.02)74,204
(17.69)22,496
(7.91)24,850
(10.22)29,890
(9.84)24,584
(9.08)26,034
(7.96)17,443
(8.00)10,917
(7.63)9,141
(8.88)240,490
(10.35)Bruise 621,707
(46.32)429,507
(43.72)7,527
(64.87)230,307
(54.91)136,417
(47.96)118,412
(48.68)139,563
(45.95)118,214
(43.64)132,801
(40.59)82,661
(37.91)51,117
(35.73)34,195
(33.21)1,051,214
(45.22)Burn 645
(0.05)400
(0.04)6
(0.05)228
(0.05)76
(0.03)169
(0.07)161
(0.05)106
(0.04)139
(0.04)80
(0.04)44
(0.03)36
(0.03)1,045
(0.04)Concussion/Cerebral contusion 43,516
(3.24)26,845
(2.73)887
(7.64)14,025
(3.34)5,768
(2.03)4,789
(1.97)7,286
(2.40)7,563
(2.79)11,015
(3.37)8,055
(3.69)6,157
(4.30)4,816
(4.68)70,361
(3.03)Organ system injury 5,100
(0.38)2,013
(0.20)19
(0.16)749
(0.18)573
(0.20)627
(0.26)994
(0.33)1,255
(0.46)1,428
(0.44)776
(0.36)432
(0.30)260
(0.25)7,113
(0.31)Others 7,848
(0.58)5,067
(0.52)118
(1.02)3,443
(0.82)1,378
(0.48)1,099
(0.45)1,365
(0.45)1,353
(0.50)1,675
(0.51)1,157
(0.53)838
(0.59)489
(0.47)12,915
(0.56)Unknown 3,644
(0.27)2,627
(0.27)217
(1.87)1,548
(0.37)643
(0.23)577
(0.24)732
(0.24)663
(0.24)777
(0.24)513
(0.24)308
(0.22)293
(0.28)6,271
(0.27)Body part injured Head 384,798
(28.67)227,560
(23.16)8,429
(72.64)230,709
(55.00)59,413
(20.89)49,434
(20.32)59,703
(19.66)52,596
(19.42)59,296
(18.12)39,548
(18.14)28,871
(20.18)24,359
(23.66)612,358
(26.34)Upper limbs 283,741
(21.14)211,456
(21.52)1,984
(17.10)96,228
(22.94)74,629
(26.24)49,769
(20.46)61,831
(20.36)54,870
(20.26)69,278
(21.18)46,598
(21.37)26,005
(18.18)14,005
(13.60)495,197
(21.30)Lower limbs 405,169
(30.19)328,755
(33.46)366
(3.15)60,896
(14.52)115,544
(40.62)98,614
(40.54)113,446
(37.35)92,441
(34.13)105,058
(32.11)67,395
(30.91)43,996
(30.75)36,168
(35.13)733,924
(31.57)Torso 179,198
(13.35)153,506
(15.63)221
(1.90)13,629
(3.25)20,056
(7.05)27,168
(11.17)46,584
(15.34)50,546
(18.66)69,549
(21.26)49,592
(22.75)34,062
(23.81)21,297
(20.68)332,704
(14.31)Multiple parts 68,494
(5.10)48,946
(4.98)300
(2.59)8,771
(2.09)11,216
(3.94)15,180
(6.24)18,402
(6.06)16,883
(6.23)19,856
(6.07)12,405
(5.69)8,464
(5.92)5,963
(5.79)117,440
(5.05)Whole body 5,100
(0.38)3,045
(0.31)27
(0.23)683
(0.16)781
(0.27)953
(0.39)1,140
(0.38)1,197
(0.44)1,500
(0.46)874
(0.40)599
(0.42)391
(0.38)8,145
(0.35)Others 14,002
(1.04)7,996
(0.81)223
(1.92)7,651
(1.82)2,534
(0.89)1,881
(0.77)2,296
(0.76)2,076
(0.77)2,296
(0.70)1,412
(0.65)946
(0.66)683
(0.66)21,998
(0.95)Unknown 1,679
(0.13)1,132
(0.12)54
(0.47)874
(0.21)286
(0.10)242
(0.10)335
(0.11)274
(0.10)321
(0.10)201
(0.09)130
(0.09)94
(0.09)2,811
(0.12)Severity Mild 994,590
(74.10)711,856
(72.46)9,972
(85.94)347,052
(82.74)228,676
(80.39)196,909
(80.95)234,505
(77.21)194,578
(71.83)220,350
(67.35)139,389
(63.93)81,896
(57.24)53,119
(51.59)1,706,446
(73.41)Moderate 320,990
(23.92)252,981
(25.75)1,530
(13.19)70,113
(16.72)53,529
(18.82)43,753
(17.99)64,762
(21.32)70,361
(25.97)97,921
(29.93)72,037
(33.04)55,408
(38.73)44,557
(43.28)573,971
(24.69)Severe 26,601
(1.98)17,559
(1.79)102
(0.88)2,276
(0.54)2,254
(0.79)2,579
(1.06)4,470
(1.47)5,944
(2.19)8,883
(2.72)6,599
(3.03)5,769
(4.03)5,284
(5.13)44,160
(1.90)Disposition Discharged after treatment 1,131,162
(84.28)818,098
(83.28)10,778
(92.88)391,909
(93.44)259,563
(91.25)220,497
(90.65)266,172
(87.63)222,532
(82.15)255,294
(78.03)162,984
(74.75)96,564
(67.49)62,967
(61.16)1,949,260
(83.85)Observed 24,281
(1.81)17,021
(1.73)233
(2.01)6,031
(1.44)4,290
(1.51)3,695
(1.52)5,037
(1.66)4,904
(1.81)6,446
(1.97)4,310
(1.98)3,372
(2.36)2,984
(2.90)41,302
(1.78)Transferred 9,352
(0.70)6,860
(0.70)39
(0.34)2,241
(0.53)1,411
(0.50)732
(0.30)1,213
(0.40)1,916
(0.71)2,844
(0.87)2,301
(1.06)1,848
(1.29)1,667
(1.62)16,212
(0.70)Admitted 171,543
(12.78)136,092
(13.85)531
(4.58)17,939
(4.28)18,150
(6.38)17,596
(7.23)30,207
(9.95)40,326
(14.89)60,879
(18.61)47,163
(21.63)40,366
(28.21)34,478
(33.49)307,635
(13.23)Dead 822
(0.06)361
(0.04)0
(0.00)75
(0.02)50
(0.02)48
(0.02)112
(0.04)180
(0.07)257
(0.08)161
(0.07)136
(0.10)164
(0.16)1,183
(0.05)Others 5,021
(0.37)3,964
(0.40)23
(0.20)1,246
(0.30)995
(0.35)673
(0.28)996
(0.33)1,025
(0.38)1,434
(0.44)1,106
(0.51)787
(0.55)700
(0.68)8,985
(0.39)Total 1,342,181
(100.00)982,396
(100.00)11,604
(100.00)419,441
(100.00)284,459
(100.00)243,241
(100.00)303,737
(100.00)270,883
(100.00)327,154
(100.00)218,025
(100.00)143,073
(100.00)102,960
(100.00)2,324,577
(100.00)Abbreviation: NISS=National Injury Surveillance System.
* Differences in characteristics between genders and age groups were all statistically significant, all P<0.001.Table 3. Characteristics of the nature, part, and severity of injuries related to falls in the NISS of China, 2019–2022.
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