title: Rural older people had lower mortality after accidental falls than non-rural older people.
abstract: OBJECTIVE
  This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people.
  
  
  METHODS
  This population-based case-control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan): a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880-E888) during 2006-2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls.
  
  
  RESULTS
  The rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%,P<0.001), but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%,P<0.001). After adjusting for age, gender, comorbidity, and medication use, the rural group had a significantly lower risk of mortality after falls than the non-rural group (adjusted odds ratio =0.32, 95% confidence interval =0.28-0.37,P<0.001). Age, gender, place of residence, comorbidity, number of medications, and inappropriate medication use were independent risk factors of mortality after falls.
  
  
  CONCLUSIONS
  The rural older people had a higher frequency of fall-related hospitalizations but lower mortality after falls than the non-rural older people. Fall prevention programs should be adjusted for difference in place of residence.
authors.affiliation: Department of Surgery, National Yang-Ming University Hospital, National Yang-Ming University, Yilan, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jen-Wu
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Yi-Ying
authors.initials: YY
authors.lastname: Lin
authors.affiliation: Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Nai-Yuan
authors.initials: NY
authors.lastname: Wu
authors.affiliation: Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; Faculty of Medicine and School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology
keywords: accidental falls; mortality; risk factors; rural population