# How socioeconomic status shapes health outcomes following severe falls: a cross-sectional analysis

## TL;DR

This study explores how education and income affect health outcomes in older adults after a severe fall.

## Contribution

The study reveals that education, not income, is most strongly linked to better mental and functional health outcomes after severe falls.

## Key findings

- Higher education is associated with better functional and mental outcomes, including ADLs and cognitive status.
- Income showed limited associations but was negatively correlated with concerns about falling.
- Age and sex were critical factors influencing key health outcomes.

## Abstract

Falls are a major health concern, leading to severe injuries, fatalities, and increased risk of future falls. Severe falls, requiring medical care, necessitate targeted interventions. Socioeconomic status (SES), measured by income and education, influences health outcomes, with lower SES linked to greater multimorbidity and reduced physical activity. While SES broadly impacts fall risk, limited research explores its effects following severe falls. Therefore, this study aims to evaluate the associations between socioeconomic status (SES) and health outcomes in older adults following a fall with presentation to the emergency department (ED).

We analyzed data from the SeFallED study, comprising individuals over the age of 60, who presented to the ED following a recent fall, without requiring subsequent hospitalization. Income and education were used to characterize SES. Health outcomes include mental and functional performance, physical activity, mental well-being, and utilization of the health system. Linear and logistic regression models, adjusted for age and sex, were used to assess associations with health outcomes, incorporating multicollinearity checks, residual diagnostics, and bias-corrected bootstrapping to ensure robustness and reproducibility.

In this cross-sectional study of 172 older adults (median age 74 years) following a severe fall, education was positively associated with functional and mental outcomes, including Activities of Daily Living (ADLs), cognitive status, hand grip strength, and physical performance (p < .001). Regression analysis, adjusting for age and sex, revealed that higher education was significantly associated with better ADLs, cognitive status, hand grip strength, and physical performance, while income showed no significant associations with these outcomes.

This study revealed that the associations with mental and functional health outcomes in older adults following a severe fall were the strongest for education, rather than income. Higher education was associated with better performance. Income showed limited associations but was negatively correlated with concerns about falling. Age and sex were critical covariates, influencing key health outcomes. These findings provide insights that may be relevant for future research and considerations in studies involving older adults presenting to EDs.

DRKS00025949 https://drks.de/search/en/trial/DRKS00025949, Registered on 4th November, 2021.

The online version contains supplementary material available at 10.1186/s12877-025-06198-9.