# Trends and Disparities in Fall‐Related Head Injury Mortality Among Middle‐Aged and Older Adults (>55 Years) in the United States: A 21‐Year National Analysis (1999–2020)

## TL;DR

This study shows that deaths from head injuries due to falls have increased among older adults in the US, with significant differences based on age, gender, race, and location.

## Contribution

The study provides a 21-year national analysis of fall-related head injury mortality disparities among adults aged ≥55 years in the US.

## Key findings

- Age-adjusted mortality rates nearly doubled from 1999 to 2020, with the highest rates in men, adults ≥85 years, and non-Hispanic Whites.
- Most deaths occurred in medical settings, and mortality rates varied significantly by state and urban–rural status.
- The study highlights the need for targeted prevention and trauma care to address rising disparities in fall-related head injury deaths.

## Abstract

Head injury is a leading cause of mortality from falls in adults aged ≥55 years. This study assessed demographic and geographic disparities in fall‐related head injury mortality among United States adults from 1999 to 2020.

Mortality data were extracted from the Centers for Disease Control and Prevention Wide‐ranging Online Data for Epidemiologic Research (CDC WONDER) database using International Classification of Diseases (ICD‐10) codes for falls (W00–W19) and head injuries (S00–S09). Age‐adjusted mortality rates (AAMRs) per 100,000 population were calculated by year, sex, race/ethnicity, state, and urban–rural status. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC). We refer to our cohort as “middle‐aged and older adults (≥55 years)” on the basis of epidemiological and trauma literature identifying midlife as the stage when fall risk and adverse head injury outcomes begin to rise. Furthermore, the World Society of Emergency Surgery (WSES) 2023 trauma guidelines explicitly recognize patients aged ≥55 years as a high‐risk population requiring special consideration, reinforcing the clinical relevance of this cutoff.

Between 1999 and 2020, 252,750 fall‐related head injury deaths occurred among adults aged ≥55 years. Most deaths occurred in medical settings (69.6%), followed by homes (9.2%), long‐term care (8.8%), and hospices (8.7%). AAMR nearly doubled, from 9.71 to 19.85, with a steeper rise from 1999 to 2007 (APC: 6.53) and slower growth thereafter (APC: 1.92). AAMRs were higher in men (22.1) than women (11.8), and highest in adults ≥85 years (81.7). Non‐Hispanic (NH) Whites had the highest AAMR (16.8), followed by NH Asians/Pacific Islanders (15.8), Hispanics (12.6), and NH Blacks (8.6). In 2020, state‐level AAMRs ranged from 9.5 (Alabama) to 24.0 (Wisconsin), with rural areas slightly exceeding urban ones (20.3 vs. 19.8).

Fall‐related head injury mortality in US adults aged ≥55 years has steadily increased. Tailored prevention strategies are critical to reducing these preventable deaths, particularly in high‐risk groups.

From 1999 to 2020, fall‐related head‐injury mortality among US adults ≥55 rose markedly, with the highest rates in men, the oldest ages, Midwestern states, and nonmetropolitan areas, underscoring widening disparities and the urgent need for targeted fall prevention and timely, equitable access to trauma care.