Kiely Dan K, Kim Dae Hyun, Gross Alden L, Habtemariam Daniel A, Leveille Suzanne G, Li Wenjun, Lipsitz Lewis A
Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA.
Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA.
J Health Dispar Res Pract. 2015 Summer;8(3):72-84.
To determine whether previously reported racial differences in fall rates between White and Black/African American is explained by differences in health status and neighborhood characteristics.
Prospective cohort.
Community.
The study included 550 White and 116 Black older adults in the Greater Boston area (mean age: 78 years; 36% men) who were English-speaking, able to walk across a room, and without severe cognitive impairment.
Falls were prospectively reported using monthly fall calendars. The location of each fall and fall-related injuries were asked during telephone interviews. At baseline, we assessed risk factors for falls, including sociodemographic characteristics, physiologic risk factors, physical activity, and community-level characteristics.
Over the mean follow-up of 1,048 days, 1,539 falls occurred (incidence: 806/1,000 person-years). Whites were more likely than Blacks to experience any falls (867 versus 504 falls per 1,000 person-years; RR [95% CI]: 1.77 [1.33, 2.36]), outdoor falls (418 versus 178 falls per 1,000 person-years; 1.78 [1.08, 2.92]), indoor falls (434 versus 320 falls per 1,000 person-years; 1.44 [1.02, 2.05]), and injurious falls (367 versus 205 falls per 1,000 person-years; 1.79 [1.30, 2.46]). With exception of injurious falls, higher fall rates in Whites than Blacks were substantially attenuated with adjustment for risk factors and community-level characteristics: any fall (1.24 [0.81, 1.89]), outdoor fall (1.57 [0.86, 2.88]), indoor fall (1.08 [0.64, 1.81]), and injurious fall (1.77 [1.14, 2.74]).
Our findings suggest that the racial differences in fall rates may be largely due to confounding by individual-level and community-level characteristics.
确定先前报道的白人与黑人/非裔美国人之间跌倒率的种族差异是否可由健康状况和社区特征的差异来解释。
前瞻性队列研究。
社区。
该研究纳入了大波士顿地区550名白人及116名黑人老年人（平均年龄：78岁；男性占36%），他们讲英语，能够在房间内行走，且无严重认知障碍。
使用每月跌倒日历前瞻性报告跌倒情况。在电话访谈中询问每次跌倒的地点及与跌倒相关的损伤情况。在基线时，我们评估了跌倒的危险因素，包括社会人口学特征、生理危险因素、身体活动及社区层面特征。
在平均1048天的随访期内，共发生1539次跌倒（发生率：806/1000人年）。白人比黑人更易发生跌倒（每1000人年分别为867次和504次跌倒；相对危险度[95%可信区间]：1.77[1.33, 2.36]）、户外跌倒（每1000人年分别为418次和178次跌倒；1.78[1.08, 2.92]）、室内跌倒（每1000人年分别为434次和320次跌倒；1.44[1.02, 2.05]）及致伤性跌倒（每1000人年分别为367次和205次跌倒；1.79[1.30, 2.46]）。除致伤性跌倒外，调整危险因素和社区层面特征后，白人高于黑人的较高跌倒率大幅降低：任何跌倒（1.24[0.81, 1.89]）、户外跌倒（1.57[0.86, 2.88]）、室内跌倒（1.08[0.64, 1.81]）及致伤性跌倒（1.77[1.14, 2.74]）。
我们的研究结果表明，跌倒率的种族差异可能很大程度上归因于个体层面和社区层面特征的混杂作用。
