Objective To investigate the epidemiologic features of fall-related injuries, and its relationships with income, education level, and senior residents in Shanghai, China.
Methods A multi-stage stratified cluster sampling approach with probability proportional to size was used to select 45 857 residents in Shanghai for home visits. Mortality and demographic data were collected from Shanghai Vital Registration System from 2001 to 2011. Records on fall-related hospitalized cases and fatalities from 164 hospitals in Shanghai were also analyzed. Logistic regression was used to control confounding from age, gender, education levels and income.
Results During 2001 to 2011, the average annual income increased by 206.63% in Shanghai; while the fall specific mortality rate increased from 10.63 per 100 000 in 2001 to 14.76 per 100 000 in 2011. The morbidity of fall was 14.70 per 1 000 in the survey. Those with family average monthly incomes lower than 500 Yuan RMB were 6.5 times as likely as to suffer from fall-related injuries than those with higher than 5 000 Yuan RMB. The residents with an education level of primary school and under showed the highest fall specific mortality and morbidity rates, 57.85 per 100 000 (73.23%) and 33.96 per 1 000 (49.24%), 22 times and 5.5 times compared with those with college degree or above, respectively. The Luwan and Jing'an districts showed the highest mortality rates (24.10 per 100 000 and 19.59 per 100 000 respectively) with leading proportions of senior residents. The mortality rate of fall in the children <5 years was the highest among children aged 0-14 years. The mortality and morbidity of fall increased dramatically with age among those aged 50 years or above, among which the 50-54 age group accounted for the largest proportion and the morbidity accelerated. The female showed higher mortality and morbidity rates of fall than the male. Combined head injuries accounted for about half of the total fatalities of fall. The relative risk of fall-related injuries was higher in lower income, lower education level, and higher age groups, with odds ratios of 1.39, 1.27, and 1.21, respectively.
Conclusion The prevention and control of fall-related injuries confronts a huge challenge. Income, education level, and age are the main risk factors for fall-related injuries. Populations under 5 years old, over 50 years old, with an education level lower than primary school, and with lower income should be the targets for intervention. More efforts are needed, such as installing comprehensive fall-related injury prevention programs to the new responsibility system of family doctors.
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