Unintentional Fall Injuries in North Carolina 2023: Data Insights & Projections

NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Unintentional Fall Injuries in North Carolina 2023 Division of Public Health Data updated March 6, 2025

Unintentional Falls Technical Notes Surveillance methods have been updated to identify any mention of an injury in our morbidity data sources. Individual records with multiple injuries listed will be included in the total for each of those injuries but only counted once for overall total injury count. Previously, only the first listed injury was counted, which has resulted in an increase in the number of specific injuries identified. For questions or for more information, see technical notes document available at https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/ Case Definitions used: Deaths ICD10 code W00-W19 listed cause of death NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 2

Technical Notes, Continued Hospitalizations Among records with an ICD-10-CM injury code,* any mention of the ICD-10-CM codes below (includes records resulting in death) Emergency Department Visits Any mention of the ICD-10-CM codes below: (includes records resulting in hospitalization or death) Falls related to pedestrian conveyance Falls V00.11-V00.89 with 6th character=1 W00-W15, W17, W19 Fall, jump, or diving into water W16 with 6th character=2 (Except 16.4 and 16.9 with 5th character=2) W18.1, W18.2, W18.3 Other falls 7th character of A or missing (reflects initial encounter, active treatment) *See technical notes document for a full list of ICD-10-CM injury diagnosis codes NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 3

Overview Vulnerable Populations Unintentional Fall Deaths Unintentional Fall Morbidity Hospitalizations and Emergency Department Visits oUnintentional Fall Injury/Harm data are available at https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/FallsData.htm oFor custom data requests see https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/DataRequest Policy.htm NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 4

The populations most at risk of falls are projected to have the fastest growth over the next 20 years 2023 Population Percent Change 2023-2043 Overall increase of 23% 2043 Population N=13,327,333 N=10,846,274 0-17 22% 0-17 19% 0-17 10% 18-44 36% 18-44 35% 18-44 21% 45-59 19% 45-59 45-59 19% 24% 60+ 36% 60+ 60+ 24% 27% 65+ 45% 65+ 65+ 21% 18% 85+ 142% 85+ 3% 85+ 2% Source: North Carolina OSBM, Standard Population Estimates, Vintage 2023 & Population Projections, Vintage 2023 NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 5

Most older adults in North Carolina are non-Hispanic White White* 76% Black* 17% American Indian* 1% Asian* 2% Hispanic 3% *Non-Hispanic Source: National Center for Health Statistics, 2023; ages 65 and older NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 6

Demographic characteristics among older adults in North Carolina Veterans 16% 43% Speak English less than "very well" 3% Have a disability 33% of housing units with people 65 and older are single person households Have less than high school 12% Have high school education/GED 30% In the labor force 18% Income below poverty level (PL) 10% Income 100%-149% of PL 10% Source: American Community Survey, 2023 5-year estimates. Table S0103: Population 65 and older NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 7

One in five older adults in NC reports trouble walking 21% Ambulatory 13% Independent living 14% Hearing 8% Cognitive 7% Self-care 6% Vision Source: American Community Survey, 2023 5-year estimates. Table S1810: Population 65 and older NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 8

Around 75% of older adults in NC have one or more chronic diseases, 2023 BRFSS 2+ chronic diseases 1 chronic disease No chronic disease 38% 65-74 32% 31% 47% 75+ 31% 22% Source: NC State Center of Health Statistics, 2023 Behavioral Risk Factor Surveillance System (BRFSS) Survey Results NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 9

Proportion of demographic groups reporting two or more falls in the last 12 months, 2023 BRFSS Overall 12% Male Female 45-54 55-64 65-74 75+ < Highschool Highschool/GED Some post highschool College Grad Disability No Disability Overall 12% 12% 12% 9% 13% 13% 14% Veteran 14% 12% 9% Non-Veteran Urban Suburban Rural 16% 12% Social Vulnerability Least vulnerable (1st Quartile) to 21% 11% 13% 9% 1st Quartile 2nd Quartile 3rd Quartile 4th Quartile 10% 11% 17% 25% 11% 5% Source: NC State Center of Health Statistics, 2023 Behavioral Risk Factor Surveillance System (BRFSS) Survey Results NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 10

Unintentional fall-related deaths are the tip of the iceberg 2,007 Deaths Despite NC s excellent reporting systems, the totalburden of fall injury in the state is unknown. 27,880 Hospitalizations 259,507 ED Visits ? EMS ? Outpatient Visits ? Medically Unattended Injuries INJURY ICEBERG INJURY ICEBERG INJURY ICEBURG INJURY ICEBURG Limited to NC Residents, 2023 Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2023) and Hospitalization Discharge Data (2023); NC DETECT (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 11

Unintentional Fall Deaths

Unintentional fall-related deaths have continued to increase over the last 10 years Number of Deaths 2,500 2,007 2,000 1,500 1,079 86% increase 1,000 500 0 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Limited to NC Residents, 2014 2023 Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2014 2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 13

second Unintentional falls were the leading cause of injury death* in 2023 Poisoning - Unintentional Fall - Unintentional MVT - Unintentional Firearm - Self-Inflicted Firearm - Assault Suffocation - Self-Inflicted Poisoning - Self-Inflicted Suffocation - Unintentional Unspecified - Unintentional Fire/Burn - Unintentional All Other Injury Deaths 4,286 2,007 1,757 1,005 739 331 210 197 159 134 880 *by mechanism and intent MVT = Motor Vehicle Traffic Limited to NC Residents, 2023 Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 14

number one Unintentional falls were the cause of injury death among older adults* Number of Deaths 89% of fall-related deaths 849 900 800 700 626 600 500 400 305 300 200 130 51 100 24 10 7 4 1 0 0 0 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 Age Group >84 *Adults ages 65 and older Limited to NC Residents, 2023 (N = 2,007) Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 15

Unintentional fall death rates are highest among those ages 85 and older Rate per 100,000 600 477.9 500 Rates begin increasing among ages 45-54 400 300 200 104.8 100 26.9 9.5 3.8 1.7 1.0 0.7 0.0 0.0 0.0 * * 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 Age Group 35-44 45-54 55-64 65-74 75-84 >84 *Rate suppressed due to count being less than 5 Limited to NC Residents, 2023 (N = 2,007) Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 16

Rates of unintentional fall-related deaths were highest among men and non-Hispanic Whites Rate per 100,000 30.0 26.4 25.0 18.6 18.4 20.0 15.0 11.7 10.0 8.1 4.6 4.5 5.0 0.0 Female Male AI/NA NH Asian NH Black NH Hispanic White NH Other NH NH - non-Hispanic; There were 0 deaths where the race/ethnicity was unknown Limited to NC Residents, 2023 (N = 2,007) Source: NC State Center for Health Statistics, Vital Statistics-Deaths (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 17

Unintentional Fall Hospitalizations

Unintentional fall-related hospitalizations increased by over the last five years 11% Number of Hospitalizations 27,880 30,000 25,220 25,000 20,000 15,000 11% increase 10,000 5,000 0 2019 2020 2021 2022 2023 Limited to NC Residents, 2019 2023 Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2019 2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 19

78% of unintentional fall-related hospitalizations occurred among adults 65 and older Number of Hospitalizations 8,489 9,000 8,000 7,199 7,000 6,007 6,000 5,000 4,000 2,996 3,000 2,000 1,206 728 504 1,000 144 130 130 123 124 100 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 >84 Age Group Age was unknown for 0 hospitalizations Limited to NC Residents, 2023 Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 20

Adults have the highest rates of unintentional fall-related hospitalizations Rate per 100,000 85 and older 4,500 4,052.5 4,000 3,500 3,000 2,500 2,000 1,500 1,421.0 1,000 102.025.5 20.3 15.1 18.0 19.8 34.6 52.6 89.1218.2 530.0 500 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 Age Group >84 Age was unknown for 0 hospitalizations Limited to NC Residents, 2023 Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 21

Unintentional fall-related hospitalization rates were highest among women and NH Whites Rate per 100,000 400.0 348.8 350.0 308.1 300.0 250.0 204.1 186.6 200.0 133.5 150.0 100.0 72.4 61.8 50.0 0.0 Female Male AI/NA NH Asian NH Black NH Hispanic White NH NH non-Hispanic Sex was unknown for 1 (<0.1%) injury hospitalizations and race/ethnicity was unknown for 312 (0.1%) injury hospitalizations Limited to NC Residents, 2023 Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 22

Unintentional Fall Emergency Department Visits

Unintentional fall-related ED visits increased by over the last five years 17% Number of ED Visits 300,000 259,507 250,000 222,102 200,000 17% increase 150,000 100,000 50,000 0 2019 2020 2021 2022 2023 Limited to NC Residents, 2019 2023 Source: NC DETECT (2019 2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 24

53% of unintentional fall-related ED visits occurred among adults 65 and older Number of ED Vistis 60,000 53,272 50,000 45,711 39,313 40,000 32,376 30,000 19,560 20,000 12,38513,956 12,105 8,687 10,000 7,1005,559 5,620 3,515 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 >84 Age Group Age was unknown for 348 ED Visits Limited to NC Residents, 2023 Source: NC DETECT (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 25

Adults have the highest rates of unintentional fall-related ED Visits Rate per 100,000 85 and older 25,000 22,130.5 20,000 15,000 8,917.5 10,000 4,032.9 5,000 2,914.52,491.5 849.6 1,008.31,445.42,357.9 1,359.51,071.6 768.2 772.9 0 <1 01-04 05-09 10-14 15-19 20-24 25-34 Age Group 35-44 45-54 55-64 65-74 75-84 >84 Age was unknown for 348 ED Visits Limited to NC Residents, 2023 Source: NC DETECT (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 26

Rates of unintentional fall-related ED visits were highest among women and NH Whites Rate per 100,000 2,810.5 2,803.7 3,000.0 2,500.0 2,161.3 2,141.8 1,961.3 2,000.0 1,500.0 1,000.0 1,000.0 497.5 500.0 0.0 Female Male AI/NA NH Asian NH Black NH Hispanic White NH NH - non-Hispanic; sex was unknown for 332 (<0.1%) injury ED visits and race/ethnicity was unknown for 3,904(<0.1%) injury ED visits Limited to NC Residents, 2023 Source: NC DETECT (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 27

Leading diagnosis codes for unintentional fall- related ED Visits 70.1% Unspecified fall 7.6% 4.1% 3.3% 1.9% 1.9% 1.8% 1.4% 0.9% 0.8% 0.8% 0.7% 0.6% 0.5% 0.4% 3.3% Fall on same level from slipping, tripping and stumbling without subsequent striking against object Fall on same level, unspecified Fall on same level from slipping, tripping and stumbling with subsequent striking against other object Other fall on same level Fall from bed Fall (on) (from) unspecified stairs and steps Other fall from one level to another Fall (on) (from) other stairs and steps Fall on and from ladder Fall on same level from slipping, tripping and stumbling with subsequent striking against unspecified object Fall from chair Fall in (into) shower or empty bathtub Fall on same level from slipping, tripping and stumbling with subsequent striking against furniture Fall from non-moving wheelchair All Other Injury Deaths Limited to NC Residents, 2023 Source: NC DETECT (2023) Analysis by Injury Epidemiology and Surveillance Unit NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 28

Summary of unintentional fall-related injuries in North Carolina In 2023, unintentional fall-related injuries resulted in: Over deaths Nearly hospitalizations Over emergency department visits Most falls occur among females and Non-Hispanic White NC residents Rates of fall-related injuries are highest in the 75-84 and 85 and older age groups 2,000 28,000 259,000 NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 29

Where to find more data on unintentional fall-related death and injury? NC Injury and Violence Prevention Branch Falls Injury Data NC DETECT Unintentional Falls Dashboard State Center for Health Statistics (SCHS) Death Certificate Data NC Health Data Query System CDC WISQARS Fatal Injury and Violence Data NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 30

IVPB Data Support now available! Book time with an IVPB epidemiologist to discuss available data products, to talk through custom data requests, or for general data questions. IVPB Data Request Policy IVPB Data Support Bookings NCDHHS, Division of Public Health | Unintentional Fall Injuries in NC, 2023 31

Questions? InjuryData@dhhs.nc.gov Injury and Violence Prevention Branch NC Division of Public Health www.dph.ncdhhs.gov/programs/chronic- disease-and-injury/injury-and-violence- prevention-branch