The incidence of fall injuries in older adults continues to increase by 1.5% per year, with substantial county-level differences in fall injuries, according to study findings published in JAMA Network.1 Hip fractures and other injuries from falls affect 4.5 million older US residents each year and cost Medicare $15 to $30 billion annually.2 Fall prevention programs should target modifiable population-level risk factors such as physical activity levels, prescribing practices, and risky home environments to reduce injury risk from falls.  

“Although fall prevention programs commonly target severe injuries, moderate injuries, including many that do not require medical treatment, may result in critical downstream health impacts that include fear of falling, social isolation, and declines in mobility and physical conditioning,” wrote the study authors.

The authors sought to document national trends and geographic variation in fall injuries. They conducted a retrospective observational analysis using Medicare Part A and B claims from January 1, 2016, through December 31, 2019, among beneficiaries 65 years and older. Using a previously validated algorithm,3 the researchers captured moderate to severe injuries based on mechanism (the external cause of morbidity and mortality codes) or diagnosis (hospital, emergency department, or outpatient claims).

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A total of 120.7 million claims were identified from 2016 to 2019 (Table). According to the study, the mean age-adjusted and sex-adjusted national quarterly fall injury rate increased from 1332 to 1391 fall injuries per 100,000 persons between 2016 and 2019, a 4.4% overall increase (or 1.5% annual growth). The US map of fall injury rates per county clearly shows the highest fall rates (2385 per 100,000 person-quarters) running down the middle of the country through Texas, Oklahoma, Kansas, Nebraska, South Dakota, North Dakota, and Montana as well as the tip of Alaska (Figure). When analyzed by location, counties at the 10th percentile of fall rates had a 42.9% lower fall injury compared with counties in the 90th percentile.

Table. Demographics Among Medicare Patients Experiencing Falls

CharacteristicsAmount, %
Women 67.4 million (55.8)
• Black adults 2.4 million (7.9)
• Hispanic adults1.7 million (4.8)
• Non-Hispanic White adults24.3 million (80.9)
• 65 to 74 years66.9 million (55.4)
• 75 to 84 years36.2 million (30.0)
• 85 years and older17.6 million (14.6)
Figure. Map of US Counties With Fall Injury Rates Per 100,000 Person-Quarters, 2016-2019

“Our findings present population-targeted risk management opportunities to stem a growing and costly public health challenge. As injuries increase, improvements in policies and practices to prevent falls seem both possible and prudent,” they concluded.


1. Hoffman G, Franco N, Perloff J, et al. Incidence of an county variation in fall injuries in US residents aged 65 years or older, 2016-2019. JAMA Netw Open. 2022;5(2):e2148007. doi:10.1001/jamanetworkopen.2021.48007

2. Hoffman  GJ, Hays  RD, Shapiro  MF, Wallace  SP, Ettner  SL.  The costs of fall-related injuries among older adults: annual per-faller, service component, and patient out-of-pocket costs. Health Serv Res. 2017;52(5):1794-1816. doi:10.1111/1475-6773.12554

3. Min  L, Tinetti  M, Langa  KM, Ha  J, Alexander  N, Hoffman  GJ.  Measurement of fall injury with health care system data and assessment of inclusiveness and validity of measurement modelsJAMA Netw Open. 2019;2(8):e199679. doi:10.1001/jamanetworkopen.2019.9679