Background The years of life lost attributed by fall injury is the main reason for the increase of disease burden of injury for the elderly. Understanding the mortality and main factors of unintentional fall of residents is beneficial to promote local precision prevention and control program for injury.

Objective This study explores the mortality of unintentional fall and the impact of an aging population in Hongkou District of Shanghai.

Methods According to the all-cause deaths database of registered residents from 2002 to 2018 in Hongkou District of Shanghai, mortality rate, standardized mortality rate, annual percentage change (APC), and average annual percentage change (AAPC) were used to analyze deaths from unintentional fall.

Results During 2002 and 2018, a total of 2 137 residents died from unintentional fall in Hongkou District, the crude mortality rate was 16.06/100 000, the China's standardized mortality rate was 2.81/100 000, and the world's standardized mortality rate was 4.80/100 000. The male crude morality rate was lower than the female rate (13.48/100 000 vs 18.58/100 000), but the male standardized mortality rates were slightly higher than the female rates (China's standardized morality rate:3.29/100 000 vs 18.58/100 000; world's standardized morality rate:5.20/100 000 vs 4.30/100 000). There were significant upward trends in the crude mortalities for males, females, and total population (AAPC=5.28%, 2.12%, and 3.39%, respectively, all P < 0.05). The China's and world's standardized mortalities for males, females, and total population were fluctuating (all P>0.05). The China's and world's standardized mortality rates due to fall on the same level (AAPC=-5.21% and -5.33%), fall involving furniture (AAPC for China's standardized mortality rate=-6.74%), and fall from stairs and ladders (AAPC=-7.20% and -7.66%) were decreasing year by year (all P < 0.05). The mortality rate (AAPC=19.05%), China's standardized mortality rate (AAPC=13.38%), and world's standardized mortality rate (AAPC=13.00%) of other fall were increasing year by year (all P < 0.05). Except the residents < 65 years and ≥ 80 years whose unintentional fall mortality rates did not show significant changes (P>0.05), those in the 65-79 years group showed a downward trend in the mortality due to unintentional fall (AAPC=-2.10%, P < 0.05). There were differences in the distribution of death causes among the residents of different sex and age groups.

Conclusion Hongkou District authority should take active measures to deal with the impact of an aging population on the rise of unintentional fall mortality.