Why have death rates from accidental falls tripled?
Since 2000, death rates from heart disease and cancer have declined, whereas deaths from accidental falls have increased threefold.
What kills more Americans—motor vehicle accidents or accidental falls?
In a survey of our newsletter readers, the majority guessed car crashes. In reality, in 2023, 47,026 Americans died from falls, compared with 44,762 from motor vehicle accidents.
That’s a big reversal from 2000, when about three times as many people died in motor vehicle accidents as from accidental falls. Since then, motor vehicle death rates have fallen 13%.
Death rates from accidental falls tripled from 2000 to 2023.
Death rate from accidental falls, crude and age-adjusted (deaths per 100,000 people)
Many major causes of death have also declined over that period: the death rate from heart disease (the most-common cause of death) dropped 19.5%. The cancer death rate (the second-most common cause) dropped 6.8%.
Meanwhile, death rates from accidental falls have tripled. Some of this increase is due to an aging population. Age is an enormous predictor of death risk by falls. From about age 40 onward, the annual death rate from falls increases by roughly 9–10% for each additional year of age. And people older than 65 grew from 12.4% of the US population in 2000 to 17.6% in 2023.
Accidental fall death rates are more than 100 times higher for people 85+ than people 45–54 years old.
Death rate (per 100,000 people) from accidental falls by age group, 2023
But an aging population only partially explains the rise in these deaths. Deaths by falls have risen 2.4-fold on an age-adjusted basis. While they have fallen among younger people and only risen slightly among the middle aged, they have risen substantially within every age bracket of the elderly.
Death rates from accidental falls increased among every elderly cohort
Percent change in death rates from accidental falls by age group, 2000–2023
What states have the most people dying from accidental falls?
Before we explore why deaths from accidental falls have risen so much, let’s discuss where death rates are highest.
The rate of deaths from accidental falls differs significantly by state, with the rate five times higher in Wisconsin, which had the most deadly accidental falls, than Alabama, which had the fewest.
Death rates from accidental falls are five times higher in Wisconsin than Alabama.
Death rate for accidental falls by state, 2023
Age-adjusted death rates from falls remain nearly 5 times higher in Wisconsin than Alabama.
Age-adjusted death rate (per 100,000 people) from accidental falls by state, 2023
One clear predictor of state-level differences in death rates from accidental falls is age. Maine and Vermont have the highest percentages of populations over the age of 65. And they rank second and third in death rates for falls.
Another state-level predictor of accidental fall death rates is wintry weather: eight of the 10 states with the highest age-adjusted rates are notably snowy.
Deaths are rising despite precautions
Before we get to some potential reasons that falls have risen, we are going to discuss some reasons we had to expect lower fall death rates. We will focus on trends among the elderly, since increases in fall deaths have been overwhelmingly driven by older age groups. Many factors, quite frankly, might have been expected to lead to a decrease in falls.
First, there have been large-scale efforts to improve awareness of the danger of falls and implement safety procedures. In 2007, the National Council in Aging started Falls Prevention Awareness Week. In 2012, the Centers for Disease Control and Prevention (CDC) launched STEADI (Stopping Elderly Accidents, Deaths, & Injuries) to provide healthcare professionals with tools to integrate fall prevention into their routine clinical practice.
Second, and relatedly, American homes have adopted guardrails to limit falls. According to the American Housing Survey, the percent of American homes with no-step entrances rose from 42.1% in 2007 to 56.3% in 2023.
Third, the elderly are reporting fewer disabilities that may be fall risk factors. According to the American Community Survey, rates of vision disability, cognitive disability, and ambulatory disability among the elderly all consistently dropped from 2010 to 2024.
Ambulatory, cognitive, and vision disability rates have dropped for people 65+ since 2010.
Percent of individuals 65 and older with various disabilities, 2010–2024
Fourth, elderly Americans are now slightly less likely to live alone, which has been shown to be a risk factor for falls. The share of people 65+ living alone fell from 30.0% in 2000 to 28.1% in 2023.
Why are death rates from accidental falls increasing?
Why have deaths from falls, on an age-adjusted basis, risen? There are at least five possible reasons.
Drugs causing falls
First, some of the increased deaths from falls may be due to prescription medications. Numerous prescription drugs, such as many antidepressants and psychotherapeutic agents, are labeled as fall risk-increasing drugs. The National Health and Nutrition Examination Survey (NHANES) asked about prescription drug use between January 1999–March 2000 and January 2017–March 2020. Over this time, Americans 65 and older went from taking, on average, 3 prescription drugs to 4.3 prescription drugs. The percent using psychotherapeutic agents rose from 9.4% to 21.0%. The percent taking antidepressants rose from 8.4% to 20.0%.
Antidepressant use among the elderly rose 138% from 1999–2000 to 2017–2020.
Percent of individuals 65 and older who took antidepressants in the past 30 days, by survey year
Alcohol and falls
Second, some of the increased deaths may be due to rising alcohol consumption. According to data from the National Survey of Drug Use and Health (NSDUH), the percentage of people aged 65 or older who consume alcohol each month increased by 16% between 2002 and 2019. From 2002–2003 to 2021–2023, the share of this group who reported binge drinking in the past 30 days rose from 7.3% to 11.4%,
Obesity and falls
Third, it may be due to increased rates of obesity. A CDC study found that obesity increased the propensity for someone to fall in a laboratory setting. And obesity rates among people 60 and older rose from about 32.8% in 2001-2002 to 38.5% in recent years.
The obesity rate for individuals 60+ has risen 18% since survey year 2001-2002.
Percent of adults age 60 and older who are obese, by survey year
Reporting changes of falls
Fourth, some of the increase may be due to changes in reporting. As people have become more aware of the danger of falls, falls that used to not be recorded as a cause of death may increasingly be reported as a cause.
One study noted that much of the rise in death from falls has been due to a rise in deaths from what are called “other falls on the same level,” rather than falls from stairs, ladders, trees, cliffs, or other heights. It argues that falls on the same level are likely to lead to comparatively minor injuries —perhaps a rib fracture —but the actual death occurs months later as the result of pneumonia or other complications. Perhaps, the authors suggest, deaths that had been exclusively attributed to the other complication are, as the risk of falls is becoming more apparent, increasingly being attributed to the fall.
Less threat from other causes
Fifth, some of the increase may be due to fewer deaths from other causes. As mentioned earlier, some risk factors for the elderly, notably cancer and heart disease, have dropped. We would expect some increase in death from falls even if the risk from falls hasn’t increased just because fewer elderly are dying in other ways.
There is no single accepted explanation for the tripling of accidental fall death rates. But the rise is far larger than population aging alone can explain. Some portion of the increase may reflect changes in reporting, as falls are more often identified as the initiating cause of death.
One explanation is the accumulation of several risk-increasing forces among the elderly — such as more medications that impair balance, higher alcohol use, and rising obesity — along with other contributing factors that are not yet well understood. Together, these forces appear to have greatly outweighed factors that should have reduced fall risk.
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