Home Medicine A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
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A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults

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Published/Copyright: July 13, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

This cohort study investigated the impact of chronic diseases on fall risk in middle-aged and older individuals, offering insights for fall prevention strategies. Analysing data from 4,670 participants aged 40+ years, we used a Cox proportional risk model to assess chronic disease types, numbers, and interactions with other factors on fall injury risk across age groups. Results showed that middle-aged adults with respiratory diseases had a 26% increased fall risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI]: 1.05–1.48), and a linear dose–response relationship was observed between chronic disease number and fall risk (p < 0.001). The study also examined interaction effects of chronic diseases with gender, disability, and fall injury history. Female middle-aged and older adults with chronic diseases had a 67% higher fall risk than their male counterparts without chronic diseases (HR = 1.67, 95% CI: 1.36–1.88). In conclusion, chronically ill middle-aged and older adults have a higher fall risk, with high-risk groups including women, those with chronic diseases, and individuals with fall injury history. Fall prevention efforts should target middle-aged adults as well.

Keywords: chronic disease; fall injury; risk factors; health management; cohort studies

1 Introduction

An estimated 36.89 million fall-related injuries occur annually across the globe. Numerous chronic conditions, such as arthritis, diabetes, and cardiovascular disease, are believed to increase the risk of fall-related injuries [1,2]. Older adults are a high prevalence group for chronic diseases, and falls in older adults are frequently associated with poor prognosis and high rates of disability, making them susceptible to serious injury and thus a widespread concern [3]. In China, falls account for more than 46% of unintentional injuries among the elderly and are the leading cause of injury-related deaths among the elderly [4,5]. In recent years, chronic diseases have shown a younger trend. The prevalence of chronic diseases in the middle-aged population aged 40–59 years in China has reached 61.24%, and the proportion of co-occurring chronic diseases accounts for 51.98% of the middle-aged population [6,7]. The study by Kistler et al. that the current disease prevention window moving forward has become a new paradigm for health management [8]. It is equally important to explore the impact of chronic disease on the recent and long-term occurrence of fall injuries in middle-aged people [9].

Nationally and internationally, research on the association between chronic disease and fall injuries is well documented [10,11]. However, most studies in China have explored the association using mainly cross-sectional data, and few cohort studies have focused on the effect of chronic disease on fall injury [12]. There is little literature discussing the impact of co-occurring chronic conditions and the interaction of chronic conditions with other risk factors on the risk of fall injury [13,14]. However, the coexistence of co-occurring chronic diseases, chronic diseases and other fall risk factors has become a significant problem for people at high risk of falls today [15]. This study used data from the elderly follow-up survey conducted by the Fifth People’s Hospital of Sichuan Province to investigate the impact of chronic diseases on fall injuries in the middle-aged and elderly population using a prospective cohort study design and to provide data support for future studies focusing on the prevention and reduction of fall injuries in middle-aged and elderly individuals.

2 Patients and methods

2.1 Data sources

The elderly follow-up survey conducted by the Fifth People’s Hospital of Sichuan Province mainly collected data from middle-aged and elderly people in 28 provinces in China, covering demographic information and health status information, and the sampling design and data quality were assessed. The baseline survey for this project started in 2012, and the follow-up survey will be conducted until 2020. A total of 6,043 eligible middle-aged and older adults ≥40 years old recruited from the 2012 baseline sample were used for the study. A total of 1,126 people withdrew from the follow-up survey due to death or loss to follow-up, and 4,917 were reported at the end of follow-up; 247 respondents with missing variables or low questionnaire reliability and validity were excluded, resulting in the inclusion of a total valid sample of 4,670 people with a mean age of 58.52 years. The difference between the frequency of middle-aged and older adults in the pre- and postsample exclusion cohorts who experienced a fall injury and those who did not was not statistically significant (χ2 = 0.598, p = 0.537), indicating that selection bias due to data cleaning was less likely. Therefore, the sample size used to analyse the impact of baseline exposure factors on follow-up outcomes in this study was 4,670 cases.

  1. Ethics approval and consent to participate: The patient in our research has signed the informed consent. This study was designed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Fifth People’s Hospital of Sichuan Province, approval number: 20191209871624.

  2. Consent for publication: Informed consent was obtained from all patients included in this study prior to the submission of data.

2.2 Baseline survey

A prospective cohort study design was used, with 4,670 middle-aged and older adults aged ≥40 years surveyed in 2012 as the baseline population. Information on exposure factors collected from the baseline survey was divided into two categories: study factors and confounding factors.

  1. The study factors are chronic disease prevalence, including cardiovascular disease (hypertension and heart disease), respiratory disease (asthma, chronic bronchitis, and emphysema), digestive disease (stomach disease and liver disease), metabolic disease (diabetes and dyslipidaemia), neurological disease (Parkinson’s disease and stroke), arthritis or rheumatism, and kidney disease.

  2. Confounding factors: These included demographic factors (gender and literacy), lifestyle factors that were more strongly associated with the risk of fall injury (length of lunch break and length of night sleep), and individual health status factors (ability to perform activities of daily living [ADL], physical pain, depressive symptoms and history of fall injury), where age was adjusted for as a stratifying factor. Both study factors and confounding factors were collected by questionnaire. Chronic disease was a condition for which a definitive diagnosis was made by the healthcare facility where the patient was interviewed. This cohort’s prevalence of chronic illnesses among middle-aged and elderly individuals is comparable to other national findings. Due to the prevalence of chronic illness co-morbidity among middle-aged and older persons, this study investigated the strength of the connection between the number of chronic diseases and the risk of injury from falls by defining the number of chronic diseases as 0, 1, 2, and ≥3 chronic diseases. Among the confounding factors, ADL and depressive symptoms were measured by the ADL scale and the Centre for Epidemiological Studies Depression Scale (CES-D) developed by Gazibara et al. [16].

The Kistler et al.’s study showed that the ADL scale and CES-D have high reliability and validity in reflecting the mental and health status of older Chinese people [17]. A history of injury from falls is widely regarded as an important risk factor in fall injury risk studies. In this study, a history of falls was defined as the occurrence of a serious fall injury in the past 2 years (2010–2011) at the baseline survey point, with severity defined by the need for medical treatment. The reason for defining fall injury history in terms of medical treatment for falls is that moderate-to-severe falls tend to cause a decline in an individual’s physical, psychological, and social functional status, which is of greater concern and reduces recall bias.

2.3 Follow-up survey

The middle-aged and elderly cohorts were followed up for fall injuries in 2014, 2017, and 2020. The outcome events obtained at the end of follow-up were categorised as “occurrence of fall injury” and “no occurrence of fall injury.” A fall injury event was defined as a fall visit from 2011 to 2018, and a fall injury was defined as not occurring if no fall injury had occurred by the end of follow-up. Due to the significant health heterogeneity between middle-aged and elderly people, the study population was divided into two groups by age stratification to analyse the effect of chronic diseases on the risk of fall injury in different age groups.

2.4 Statistical analysis

R 4.0 software was employed for data cleansing and statistical analysis. The life table method was used to calculate fall injury reporting rates for middle-aged adults aged 40–59 years, older adults aged ≥60 years, and the full sample population during the follow-up period; descriptive statistics on baseline exposure characteristics of the sample population by the occurrence of fall injury and non-occurrence of fall injury event outcomes, with n (%) representing the distribution of categorical variables, and log-rank one-way tests were used to analyse the relationship between exposure factors and middle-aged and older adults. A Cox proportional risk model was used to evaluate the strength of the association between the various categories of chronic illnesses, the number of chronic diseases, and the risk of fall injury in the middle-aged and elderly population, and to determine the hazard ratio (HR) and its 95% confidence interval (CI). Finally, an additive model was utilised to examine the effect of the interaction between chronic diseases and other exposure factors on the likelihood of falls and injuries in middle-aged and elderly individuals. Two-sided test was conducted for inferential statistics, and p < 0.05 was considered statistically significant.

3 Results

3.1 Reporting rate of fall injuries

As shown in Table 1, using the 2,012 baseline survey as a starting point, the fall injury reporting rates for the 4,670 study participants at 2, 5, and 7 years of follow-up were 7.98% (95% CI: 7.64–8.26%), 14.63% (95% CI: 13.52–15.03%), and 27.11% (95% CI: 26.24–29.68%), respectively. The three-time follow-up fall injury reporting rates for the 2,573 middle-aged adults were 7.19% (95% CI: 6.91–7.43%), 13.52% (95% CI: 12.84–14.18%), and 19.27% (95% CI: 18.79–19.64%), respectively. The three-time fall injury reporting rates for the 2,097 older adults were 8.96% (95% CI: 8.58–9.31%), 15.16% (95% CI: 14.86–15.53%), and 35.19% (95% CI: 34.99–35.86%), respectively. indicating that close to 1/6 of middle-aged adults aged 40–59 years and more than 1/3 of older adults ≥60 years had a fall injury event within 8 years of follow-up, respectively.

Table 1

Reporting rate of fall injuries during the follow-up period for 4,560 middle-aged and elderly people

Survey year 40–59 years old (injuries/effective sample) ≥60 years old (injuries/effective sample) Total fall injury reporting rate (95% CI)
Baseline /2,573 /2,097 /
2012
2014 185/2,573 188/2,097 7.98 (7.64–8.26)
2017 348/2,573 318/2,097 14.63 (13.52–15.03)
2020 496/2,573 742/2,097 27.11 (26.24–29.68)

3.2 Results of the one-way analysis

The baseline characteristics are shown in Table 2, where gender, education, ADL, physical pain, depressive symptoms, history of fall injury, cardiovascular disease, respiratory disease, digestive disease, arthritis, renal disease, length of lunch break, and length of sleep were statistically associated with the risk of fall injury in middle-aged adults (p < 0.01); gender, education, ADL, physical. There was a statistical association between gender, education level, ADL, physical pain, depressive symptoms, history of fall injury, digestive disorders, arthritis, renal disorders, length of lunch break, length of sleep, and risk of fall injury in older adults (p < 0.01). There was a statistical link between the remaining exposure variables and risk of fall injury in middle-aged and older persons; however, there was no statistical association between neurological and metabolic illnesses and risk of fall injury (p < 0.01). The other exposure variables were statistically linked with the risk of fall injury in adults aged middle-aged and older (p < 0.01).

Table 2

Baseline characteristics of respondents and log-rank one-way test

Variables 40–59 years old (n = 2,573) ≥60 years old (n = 2,094) Total (n = 4,670)
Injuries falls (n = 496) No fall injuries (n = 2,077) p value Injuries from falls (n = 742) No fall injuries (n = 1,352) p value Injuries from falls (n = 1,238) No fall injuries (n = 3,432) p value
Sex <0.001 <0.001 <0.001
Male 168 872 296 621 464 1,493
Female 328 1,205 446 731 774 1,936
Education level <0.001 <0.001 0 0 <0.001
Primary school and below 132 358 306 518 438 876
Junior high school 149 825 323 604 472 1,429
High school and above 115 894 113 230 228 1,124
Ability to perform ADL <0.001 <0.001 0 0 <0.001
Yes 422 2,036 685 1,249 1,107 3,285
No 74 41 57 103 131 144
Physical pain <0.001 <0.001 0 0 <0.001
No 266 1,629 434 894 700 2,523
Yes 230 448 308 458 538 906
Depressive symptoms <0.001 <0.001 0 0 <0.001
No 304 1,447 399 958 703 2,405
Yes 192 630 343 394 535 1,024
History of injuries from falls <0.001 <0.001 0 0 <0.001
No 413 1,894 618 1,217 1,031 3,111
Yes 83 183 124 135 207 318
Cardiovascular disease 0.011 0.006 0 0 <0.001
No 319 1,752 383 958 702 2,710
Yes 177 325 359 394 536 719
Respiratory diseases <0.001 0.157 0 0 <0.001
No 431 1,961 689 1,186 1,120 3,147
Yes 65 116 53 166 118 282
Digestive system diseases <0.001 0.007 0 0 <0.001
No 299 1,594 509 984 808 2,578
Yes 197 483 233 368 430 851
Metabolic system diseases 0.462 0.571 0 0 0.898
No 415 1,828 677 1,104 1,092 2,932
Yes 81 249 65 248 146 497
Neurological disorders 0.358 0.452 0 0 0.406
No 471 2,024 697 1,281 1,168 3,305
Yes 25 53 45 71 70 124
Arthritis <0.001 <0.001 0 0 <0.001
No 329 1,542 384 905 713 2,447
Yes 167 535 358 447 525 982
Kidney disease <0.001 0.001 0 0 <0.001
No 443 1,993 669 1,194 1,112 3,187
Yes 53 84 73 158 126 242
Length of naps (min) <0.001 <0.001 0 0 <0.001
No naps 281 760 404 684 685 1,444
<30 57 475 85 167 142 642
≥30 158 842 253 501 411 1,343
Length of sleep (h) <0.001 742 1,352 <0.001 742 1,352 <0.001
<5 113 544 261 65 374 609
5–8 181 704 234 528 415 1,232
≥8 202 829 247 759 449 1,588

3.3 The impact of different chronic diseases on the risk of injury from falls

As shown in Table 3, after adjusting for the confounding effects of gender, education, ADL, physical pain, depressive symptoms, history of fall injury, length of lunch break, and length of sleep, the results of the Cox proportional risk regression model for the group of middle-aged adults aged 40–59 years showed that compared with middle-aged adults without respiratory disease, having respiratory disease increased the risk of fall injury by 26% (HR = 1.26, 95% CI: 1.05–1.48), and arthritis increased the risk of fall injury by 38% (HR = 1.38, 95% CI: 1.29–1.48). Cox proportional risk regression models for the group of older adults aged ≥60 years showed that arthritis increased the risk of fall injury by 21% (HR = 1.21, 95% CI: 1.16–1.28), and kidney disease increased the risk of injury from falls by 31% (HR = 1.31, 95% CI: 1.12–1.47). The results of the Cox proportional risk regression model for the middle-aged and elderly groups showed that having respiratory disease increased the risk of injury from falls by 19% (HR = 1.19, 95% CI: 1.11–1.32), having arthritis increased the risk of injury from falls by 28% (HR = 1.28, 95% CI: 1.16–1.37), and having kidney disease increased the risk of injury from falls by 24% (HR = 1.24, 95% CI: 1.14–1.37).

Table 3

A Cox proportional risk regression model of the effect of different chronic conditions on the risk of injury from falls in middle-aged and older adults

Variables 40–59 years old 40–59 years old Total
Cardiovascular disease
No 1.00 1.00 1.00
Yes 1.04 (0.89–1.17) 1.08 (0.95–1.19) 1.06 (0.92–1.16)
Respiratory diseases
No 1.00 1.00 1.00
Yes 1.28 (1.12–1.39) 1.05 (0.96–1.13) 1.19 (1.11–1.32)
Digestive system diseases
No 1.00 1.00 1.00
Yes 1.06 (1.01–1.20) 0.98 (0.91–1.06) 1.02 (0.99–1.08)
Neurological disorders
No 1.00 1.00 1.00
Yes 0.86 (0.71–1.02) 1.09 (0.89–1.18) 0.97 (0.94–1.06)
Arthritis
No 1.00 1.00 1.00
Yes 1.38 (1.29–1.48) 1.21 (1.16–1.28) 1.28 (1.16–1.37)
Kidney disease
No 1.00 1.00 1.00
Yes 1.08 (1.01–1.15) 1.31 (1.12–1.47) 1.24 (1.14–1.37)

3.4 The effect of the number of chronic diseases on the risk of injury from falls

The results of the Cox proportional risk regression model are shown in Table 4. After adjusting for confounders, having 1, 2, and ≥3 chronic conditions increased the risk of fall injury in middle-aged and older adults by 29% (HR = 1.31, 95% CI: 1.20–1.39), 39% (HR = 1.39, 95% CI: 1.26–1.51) and 46% (HR = 1.46, 95% CI: 1.37–1.63), respectively. By age group, having 1, 2, and ≥3 chronic conditions increased the risk of fall injury by 35, 47, and 54% in middle-aged adults aged 40–59 years, respectively; older adults aged ≥60 years with ≥3 chronic conditions had a 31% higher risk of fall injury than those without chronic conditions (HR = 1.31, 95% CI: 1.24–1.38). The trend test showed that the association between the number of chronic conditions and the risk of fall injury was a dose‒response relationship in the middle-aged, elderly, and combined middle-aged and elderly groups, indicating that the higher the number of chronic conditions in middle-aged and elderly people, the higher the risk of fall injury. The overall χ2 value of the trend test was further decomposed into a linear regression component and a partial linear regression component, and it was found that the linear regression component was statistically significant in the middle-aged and elderly groups, while the partial linear regression component was not statistically significant, and both components were statistically significant after age grouping, indicating a linear relationship between the number of chronic diseases and the risk of fall injury in the middle-aged and elderly groups.

Table 4

Dose–response relationship between the number of chronic diseases and the risk of injury from falls in middle-aged and elderly people

Model A 40–59 years old (n = 2,573) ≥60 years old (n = 2,097) Total (n = 4,670)
Number of chronic diseases
0 1.00 1.00 1.00
1 1.35 (1.27–1.51) 1.21 (1.10–1.32) 1.29 (1.20–1.39)
2 1.47 (1.31–1.59) 1.25 (1.14–1.43) 1.39 (1.26–1.51)
≥3 1.54 (1.44–1.68) 1.31 (1.24–1.38) 1.46 (1.37–1.63)
Trend test
χ2 value 78.62 51.04 129.78
p value <0.001 <0.001 <0.001
Pr value <0.001 <0.001 <0.001
Pb value 0.019 0.008 0.329

3.5 The effect of chronic disease interacting with other factors on the risk of injury from falls

As shown in Table 5, after adjusting for confounders, the risk of fall injury was 67% higher for female middle-aged and older adults with chronic disease than for male middle-aged and older adults without chronic disease (HR = 1.67, 95% CI: 1.36–1.88), 68% higher for disabled middle-aged and older adults with chronic disease than for non-disabled middle-aged and older adults without chronic disease (HR = 1.68, 95% CI: 1.43–1.81), and middle-aged and older adults with a history of chronic disease and fall injury had a 162% higher risk of fall injury than middle-aged and older adults without a history of chronic disease and fall injury (HR = 2.62, 95% CI: 2.51–2.94). Female middle-aged adults with chronic disease had a 61% greater risk of fall injury than male middle-aged adults without chronic disease, while disabled middle-aged adults with chronic disease had a 54% greater risk of fall injury than middle-aged adults without chronic disease and non-disabled adults, and middle-aged adults with a history of chronic disease and fall injury had a 189% higher risk of fall injury than middle-aged adults without a history of chronic disease and fall injury. Similarly, the interaction of having a chronic disease with other exposure factors increased the risk of fall injury in older adults by 78, 76, and 139%, respectively.

Table 5

The effect of the interaction of chronic disease and other factors on the risk of injury from falls in middle-aged and older people

Models 40–59 years old (n = 2,573) ≥60 years old (n = 2,097) Total (n = 4,670)
Model 1
Chronic diseases Sex
No Male 1.00 1.00 1.00
Yes Male 1.19 (1.12–1.39) 1.07 (1.03–1.28) 1.13 (1.07–1.35)
No Female 1.17 (1.08–1.32) 1.39 (1.16–1.52) 1.26 (1.12–1.44)
Yes Female 1.61 (1.42–1.78) 1.78 (1.51–1.96) 1.67 (1.36–1.88)
Model 2
Chronic diseases Ability to perform ADL
No Yes 1.00 1.00 1.00
Yes Yes 1.29 (1.20–1.36) 1.22 (1.17–1.49) 1.26 (1.24–1.38)
No No 0.94 (0.79–1.07) 1.62 (1.14–1.98) 1.25 (0.86–1.73)
Yes No 1.54 (1.21–1.76) 1.76 (1.52–2.10) 1.68 (1.43–1.81)
Model 3
Chronic diseases History of injuries from falls
No No 1.00 1.00 1.00
Yes No 1.40 (1.31–1.64) 1.21 (1.13–1.49) 1.33 (1.24–1.36)
No Yes 2.94 (2.45–3.70) 1.69 (1.32–1.98) 2.17 (1.94–2.69)
Yes Yes 2.89 (2.51–3.06) 2.39 (1.97–2.84) 2.62 (2.51–2.94)

4 Discussion

This study indicated that the incidence of fall injuries was significantly higher in older people aged 60 years than in middle-aged people aged 40–59 years [18]; nonetheless, with the trend towards younger age groups with chronic diseases, middle-aged people also face a public health issue of a higher risk of fall injuries due to multiple chronic diseases [19,20]. This study revealed that both the type and number of chronic diseases had a significant effect on the incidence of fall injuries, with arthritis, renal and respiratory diseases, and comorbidities being independent risk factors for fall injuries in middle-aged and older adults, and that women, people with ADL impairment, and a history of fall injuries in middle-aged and older adults with chronic diseases were at high risk for fall injuries.

Hoffman et al.’s study showed that having arthritis leads to chronic motor dysfunction in older people, which increases the risk of fall injuries [21]. This study shows that middle-aged patients with arthritis also need attention to prevent fall injuries, which is consistent with Hoffman et al.’s study. A meta-analysis of fall injuries in adults with arthritis showed that impaired balance, muscle weakness, increased comorbidity, and knee pain were all risk factors for fall injuries in adults. In terms of the biomechanical and sports medicine processes involved in falls, patients with knee osteoarthritis often need to compensate for reduced weight-bearing capacity by prolonging lower limb support, reducing stride length, and increasing stride width when walking or exercising, resulting in greater reliance on hip abductors and extensors and difficulties in weight transfer, resulting in increased mechanical stress on the knee joint and disruption of body balance [22,23]. The immunopathogenesis of rheumatoid arthritis is not yet fully understood. However, research indicates that the arthritic process is accompanied by the ageing of muscle function, including bone fragility, loss of cartilage flexibility, deterioration of muscle strength, and loss of ligament flexibility, which all increase the risk of fall injury [24,25].

This study found that both kidney disease and respiratory disease were associated with an increased risk of fall injury in middle-aged and older adults. A cross-sectional study by Rai et al. [26] found no association between kidney disease and fall injury risk after adjusting for potential confounders but acknowledged that fall injury is a common problem in older people with kidney disease. As renal disease is often complicated by health problems, such as anaemia, disorders of calcium and phosphorus metabolism, and hypoproteinaemia, as renal function declines, predisposing to dizziness and weakness, malnutrition, and osteoporosis, the results of this study support the use of renal disease as a predictor for identifying people at high risk of falls.

Current research on the association between respiratory disease and risk of injury from falls has focused on chronic obstructive pulmonary disease (COPD), a common chronic bronchitis or emphysema disease. Milla’s study demonstrated the association between the number of chronic diseases and the risk of falls [27]. Jamas’ study reported an increased risk of falls in older people with chronic diseases [28]. A cross-sectional study by Lohman et al. [29] based on 9,258 community-dwelling older adults (≥60 years) found that the risk of injury from falls in older adults was primarily associated with COPD. This may be because COPD affects isometric knee extension, walking speed, single-leg posture, and limb balance in humans.

There is no conclusive evidence that neurological and cardiovascular diseases are risk factors for fall injury. Consistent with the results of this study, a cohort study in the USA showed that neurological disease (combined stroke and Parkinson’s disease) was not associated with the risk of injury from falls, and a case‒control study by Scott et al. [30] based on cross-sectional data found no association between having neurological disease and the risk of injury from falls, consistent with this study. A systematic review of cardiovascular disease and the risk of falls in people aged ≥50 years showed inconsistent associations between specific symptoms of cardiovascular disease and the risk of fall injury. The aetiological hypothesis between neurological disorders, cardiovascular disease, and fall injury needs to be further investigated in the future [31].

This study determined that the risk of damage from falls rose linearly with the number of chronic conditions in middle-aged and elderly individuals. Chronic diseases influence indices of physical function, somatic pain, general health, vitality, and mental health, and the greater the number of chronic diseases, the lower the overall health status and quality of life of older individuals. Cai et al.’s study [32] concluded that overall pain measures were associated with an increased risk of injury from falls in older people, which is generally consistent with the results of this study. The dose–response association between the number of chronic illnesses and the risk of injury from falls may be attributable to the cumulative or synergistic harm induced by several chronic conditions. Bhasin et al.’s study [33] included 4,050 female older adults (aged 60–79 years) and found a linear trend between the risk of fall injury and the prevalence of chronic disease, but no linear relationship was observed in this study among older adults aged ≥60 years. However, the cumulative effect of chronic disease prevalence on the risk of injury from falls was validated in this study [34].

Current research is less likely to discuss the impact of chronic disease interacting with other risk factors on the risk of fall injury. Gender, ADL, and history of fall injury are recognised risk factors for fall injury, and this study showed that women, middle-aged, and older people with chronic disease with impaired ADL and a history of fall injury had 1.67 (95% CI: 1.36–1.88), 1.68 (95% CI: 1.43–1.81), and 2.62 (95% CI: 2.51–2.94) times the rate of fall injury than men, middle-aged, and older people with intact ADL and never had a fall or chronic illness. 1.68 (95% CI: 1.43–1.81) and 2.62 (95% CI: 2.51–2.94) times more likely to have a history of falls. This finding is similar to the dose‒response relationship between chronic disease prevalence and fall injury risk, suggesting that the accumulation or synergy of risk factors significantly increases the risk of fall injury.

This study influence of chronic illness prevalence on the risk of fall injury in middle-aged and elderly individuals was investigated using a prospective cohort research design with a large sample size. A dose–response association was discovered between the prevalence of chronic illness and the risk of fall injury, giving solid evidence for the prevention and reduction of fall risk in middle-aged and older individuals. Follow-up studies will continue to study potential techniques for lowering the risk of falls among middle-aged and elderly adults, hence reducing the risk of falls in a variety of contexts for middle-aged and elderly individuals.

There are some limitations to this study in that information on fall injuries and chronic illnesses was obtained through self-reporting and may be subject to recall bias, but the use of a fall visit as a defining criterion for fall injuries in this study was able to reduce recall bias to a greater extent, and the use of illness diagnosed by a healthcare facility as a study factor made recall bias less likely and the results reliable. In addition, this study did not control for the influence of the home environment and social support factors.

5 Conclusion

This study reveals a dose–response relationship between chronic diseases and fall injuries in middle-aged and older adults. Prioritising fall prevention in middle age and managing chronic conditions can effectively reduce fall injuries and associated healthcare costs. The findings highlight the importance of early identification and management of chronic diseases to mitigate fall risks. Healthcare professionals should implement regular screenings, patient education, and comprehensive management plans tailored to this population’s unique needs. By addressing the complex interplay of chronic diseases and other risk factors, a proactive approach to fall prevention can be established, ultimately improving the quality of life for middle-aged and older adults.

Acknowledgement

We would like to acknowledge helpful comments from editors and reviewers.

  1. Funding information: This work was supported by the National Natural Science Foundation of China (No. 20192313).

  2. Author contributions: Conceptualisation: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Methodology: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Validation: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Formal analysis: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Investigation: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Resources: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Data Curation: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Writing – Original Draft: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Writing – Review & Editing: Xue Yang, Longxin Li, Fang Xie, and Zhang Wang. Supervision: Xue Yang, Fang Xie, and Zhang Wang. Project administration: Xue Yang and Zhang Wang.

  3. Conflict of interest: The authors declare that there is no conflict of interest regarding the publication of this article.

  4. Data availability statement: The data used to support the findings of this study are included within the article.

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Received: 2022-11-29
Revised: 2023-06-19
Accepted: 2023-06-20
Published Online: 2023-07-13

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
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  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
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  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
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  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
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  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0748
Keywords for this article
chronic disease; fall injury; risk factors; health management; cohort studies
Creative Commons
BY 4.0

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  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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