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Trends and projections in fall death in the Netherlands from 1990 to 2045
  1. Niels van der Naald1,
  2. Frank Verbeek2,
  3. David Nico Baden3,
  4. Anna J M Verbeek4,
  5. Wietske H W Ham5,6,
  6. Jan Verbeek7,
  7. Erik Brummelkamp8,
  8. Hans Groenewoud8,
  9. Catharina Stolwijk-van Niekerk8,
  10. André Verbeek8
  1. 1Department of Emergency Medicine, OLVG Hospital, Amsterdam, The Netherlands
  2. 2School of Health Studies, HAN University of Applied Sciences–Campus Nijmegen, Nijmegen, The Netherlands
  3. 3Department of Emergency Medicine, Diakonessenhuis Hospital, Utrecht, The Netherlands
  4. 4Department of Emergency Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
  5. 5Department of Emergency Medicine, UMC Utrecht, Utrecht, The Netherlands
  6. 6Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
  7. 7Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
  8. 8Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
  1. Correspondence to Dr Niels van der Naald, Emergency Medicine, OLVG, Amsterdam 1091AC, The Netherlands; n.naald{at}


Background Increasing life expectancy in high-income countries has been linked to a rise in fall mortality. In the Netherlands, mortality rates from falls have increased gradually from the 1950s, with some indication of stabilisation in the 1990s. For population health and clinical practice, it is important to foresee the future fall mortality trajectories.

Methods A graphical approach was used to explore trends in mortality by age, calendar period and cohorts born in the periods of 1915–1945. Population data and the numbers of people with accidental fall fatality as underlying cause of death from 1990 to 2021 were derived from Statistics Netherlands. Age-standardised mortality rates of unintentional falls per 100 000 population were calculated by year and sex. A log-linear model was used to examine the separate effects of age, period and cohort on the trend in mortality and to produce estimates of future numbers of fall deaths until 2045.

Results While the total population increased by 17% between 1990 and 2021, absolute numbers of fall-related deaths rose by 230% (from 1584 to 5234), which was 251% (an increase of 576 deaths in 1990 to 2021 deaths in 2020) for men and 219% (from 1008 to 3213) for women. Age-standardised figures were higher for women than men and increased more over time. In 2020, 79% of those with death due to falls were over the age of 80, and 35% were 90 years or older. From 2020 to 2045, the observed and projected numbers of fall deaths were 2021 and 7073 for men (250% increase) and 3213 and 12 575 for women (291% increase).

Conclusion Mortality due to falls has increased in the past decades and will continue to rise sharply, mainly caused by growing numbers of older adults, especially those in their 80s and 90s. Contributing risk factors are well known, implementation of preventive measures is a much needed next step. An effective approach to managing elderly people after falls is warranted to reduce crowding in the emergency care and reduce unnecessary long hospital stays.

  • death
  • accidental falls
  • epidemiology
  • Frail Elderly

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • Handling editor Kirsty Challen

  • NvdN and FV contributed equally.

  • Contributors Designing and planning of the study: NvdN, FV, CS-vN, AV. Data acquisition: EB, AV. Conduct of the study: NvdN, FV, JV, HG. Statistical analysis and interpretation of the data: EB, HG, JV, AV. Reporting of the work: FV, NvdN, CS-vN, WHWH, DNB. Critical revision of the work for important intellectual content: DNB, AJMV, WHWH. Responsible for the overall content as guarantors: NvdN, FV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.