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Unintentional falls, defined by the WHO as events in which an individual comes to rest on the ground, are the leading cause of non-fatal injury-related emergency department visits in the United States (CDC). Of the over 8 million unintentional fall-related ED visits that occurred in the US in 2019, about 40% of patients were 65 years of age or older (CDC). Similarly, of 2019’s 39,443 fatal falls, 34,212(87%) were older adults.

Treatment of elderly fatal and non-fatal falls incurs a substantial cost, an estimated $50 billion in 2015. One recent study found that, within North Carolina, elderly fall-related ED visits cost an estimated $236 million, while injuries severe enough to require hospitalization led to costs of almost $700 million. In this edition of Stories from the dashboard, we will be investigating characteristics of unintentional fall injuries and where in North Carolina they are occurring using NC DETECT’s Unintentional Falls Dashboard.

In 2020, there were 183,339 unintentional fall-related ED visits across North Carolina. Females presented to the ED more often than males (59% versus 41%) and 73% of presentations were individuals of White race. When stratified by age, the plurality of patients were 65 years or older (n=84,134, 46% of visits). Injuries among older adults occured at a rate of 4,804.7 per 100,000 person-years, higher than the 2018 national rate of 4,362.1 per 100,000 person-years. Interestingly, the rate of injury among 65-to-74 year-olds was similar to the national average, while those age 75-84 and 85+ had higher rates compared to national estimates.

County level rates for unintentional fall-related ED visits among adults age 65+, 2020. Taken from the NC DETECT Unintentional Falls Dashboard.

At the county level, rates of unintentional fall-related ED visits among adults age 65+ ranged from 870 per 100,000 person years (Warren County, red dot in figure) to 9,353 per 100,000 person years (Avery County, yellow dot in figure). It should be noted that NC DETECT reflects data obtained from civilian hospitals in NC only; North Carolinians that visit EDs in other states – which may be common in border counties – are not reflected in these rates.

The dashboard also lets us investigate the overall proportion of unintentional fall-related visits by zip-code of residence. Residents of zip codes 28577 (part of Carteret County) and 28749 (part of McDowell County) had the highest proportion of unintentional fall-related visits at 15.79%. The lowest proportion of visits were among residents with zip code 28358 in Robeson County – just 0.26% of their ED visits were due to unintentional falls.

If you would like to further investigate detailed county-level demographics of unintentional fall-related ED visits, we recommend checking out the dashboard. Additionally, registered NC DETECT users can use the web application to address any specific queries they may have.

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