Examining Variation in County-Level Fall-Related Injury Rates among Older Adults

Purpose: To explore geographic variability in FRI rates and relationships between a county’s sociodemographic and health care resources and FRI rates over time.

Methods:  Using California OSHPD and Department of Finance and AHRF data, random intercepts models were used to estimate county-level hospital (2000-08) and emergency department (ED) (2005-08) FRI rates per 100,000 older adults, controlling for the racial/ethnic and gender proportions in the county’s older adult population and the number of physicians, nursing facilities (NF), and home health agencies (HHA) per 10,000 older adults.

Results: Unadjusted hospital (mean: 1,757.0, SD: 425.9) and ED (mean: 4,989.0, SD: 1,509.2) FRI rates per 100,000 older adult population varied more than five-fold across counties. In adjusted analyses, counties with more health care infrastructure per older adult population had higher county hospital and ED FRI rates compared to other counties. The adjusted hospital FRI rate increased from 1,724.6 at two NFs to 1,923.5 at 10 NFs per 10,000 older adults and from 1,692.3 to 1,895.4 FRIs at counties with zero and four HHAs per 10,000 older adults. There were 3,912.3 and 5,967.1 estimated ED FRIs for counties with zero and with 10 NFs and 4,682.5 and 5,643.9 ED FRIs for counties with zero and with four HHAs per 10,000 older adults.

Conclusion: Adjusted county-level hospital and ED FRI rates are highly variable across California’s counties and county-level healthcare resources may affect behaviors and health that contribute to FRI risk. Population-wide FRI prevention efforts will require efforts tailored to counties’ older adult populations and resources.