Effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil from 1980 to 2019
Authors: Silva José Mário Nunes da , Idalino Rita de Cássia de Lima 
Published: July 2024

AbstractAim:This study aimed to estimate the effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil and its geographic regions, by sex, from 1980 to 2019.Methods:We conducted an ecological time-series study using data on fall-related deaths in older people extracted from the official mortality information system. Poisson models were adjusted for each sex and geographic region to estimate age-period-cohort effects.Results:From 1980 to 2019, Brazil recorded 170,607 fall-related deaths in older adults, with 50.1% occurring in women. More than half of these deaths occurred in the 80 years or older age group (55.0%) and in the Southeast region (52.0%). We observed an increase in fall-related mortality rates (FMR) across all age groups and regions, regardless of sex. There was an increased risk of death in all periods after the reference period (2000 to 2004) in all geographic regions and for both sexes. We also observed a gradual increase in mortality risk for men born before 1914 and after 1935 compared to the reference cohort (1930 to 1944). In contrast, we found a protective effect across all birth cohorts for women.Conclusion:There was a consistent increase in fall-related mortality risk among older people in Brazil, posing a public health challenge. The findings highlight the urgent need for implementing public health policies promoting older adult health and preventing fall risks to improve the quality of life for this population.What is new?Key FindingsThe study found a consistent increase in fall-related mortality rates (FMR) among older adults in Brazil from 1980 to 2019.Age Effect: Fall-related mortality rates (FMR) increased progressively with advancing age. More than half of the fall-related deaths occurred in individuals aged 80 years or older (55.0%).Period Effect: There was an increased risk of death in all periods after the reference period (2000 to 2004) across all geographic regions and for both sexes.Cohort Effect: For men, there was a gradual increase in mortality risk for those born before 1914 and after 1935 compared to the reference cohort (1930 to 1944). For women, a protective effect was observed across all birth cohorts.What This Adds to What Was Known?This study is one of the first to analyze fall-related mortality trends in Brazil using the age-period-cohort (APC) model.Traditional studies have typically focused on time trends of standardized rates, which consider age and period effects but often overlook the impact of different birth cohorts.What Is the Implication and What Should Change Now?The findings highlight the urgent need for public health policies to promote older adult health and prevent falls, focusing on both healthcare and physical environments to mitigate increasing mortality risk.Enhancing public health strategies to prevent falls can improve the quality of life for the elderly population in Brazil and mitigate the public health challenge posed by the rising trend in fall-related mortality.