title: The impact of geographical location on trends in hospitalisation rates and outcomes for fall-related injuries in older people.
abstract: OBJECTIVE
  This population-based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall-related injury in older adults, adjusting for age, sex and comorbidities.
  
  
  METHODS
  A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall-related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths-of-stay, 28-day readmissions, and 30-day mortalities. These were standardised for age, sex, comorbidity, and remoteness.
  
  
  RESULTS
  Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28-day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30-day mortality (5.0% vs 4.9%, p=0.0046).
  
  
  CONCLUSIONS
  Over the study period, rural residents of NSW had lower rates of fall-related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length-of-stay, but higher rates of readmission and mortality. These differences existed following standardisation.
  
  
  CONCLUSIONS
  This study highlights the need for further research to characterise and explain this variability.
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, New South Wales.|Prince of Wales Clinical School, UNSW Australia, New South Wales.
authors.forename: Dharan W
authors.initials: DW
authors.lastname: Sukumar
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, New South Wales.
authors.forename: Lara A
authors.initials: LA
authors.lastname: Harvey
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, New South Wales.|Australian Institute of Health Innovation, Macquarie University, New South Wales.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mitchell
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, New South Wales.|Prince of Wales Clinical School, UNSW Australia, New South Wales.
authors.forename: Jacqueline C T
authors.initials: JC
authors.lastname: Close
mesh_terms: D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009517:New South Wales; D010359:Patient Readmission / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: accidental falls; aged; data linkage; geography; hospitalisation