School of Earth and Environment, University of Canterbury, New Zealand.
Department of Population Health, University of Otago Christchurch, New Zealand.
Soc Sci Med. 2021 Nov;288:113212. doi: 10.1016/j.socscimed.2020.113212. Epub 2020 Jul 21.
Falls are a leading cause of injury and accidental death, particularly amongst older people. Evidence of environmental risk factors for pedestrian falls among older adults could support age-friendly urban design and contribute to efforts to reduce the incidence of pedestrian falls and support outdoor mobility among older adults. Yet investigation of the environment in which pedestrian falls occur is often hampered by its reliance on participant recall and self-report information. We identified the point locations of falls occurring on the road or street among adults that were attended by an ambulance in New Zealand over a two-year period (2016-2018) and connected these to a range of social (e.g. deprivation) and environmental (e.g. slope, greenspace) risk factors. Three types of analysis were used: a descriptive analysis of fall rates, logistic regression assessing whether a patient was transported to hospital following a fall, and a negative binomial regression analysis of the pedestrian falls by small area. We found a number of differences in the built environment surrounding fall locations between age groups. Compared with younger age groups, older adults showed high fall rates closer to home, and higher fall rates in areas with many types of destinations nearby. Additionally, our results showed a higher rate of pedestrian falls in more deprived areas. People who live in more deprived areas also fell over more frequently, but the pattern is stronger based on deprivation at the fall location, rather than home location. Residents of more deprived areas were less likely to be transported to hospital following a fall. Thus, our findings have equity implications for both environments and patient experience. These patterns could not have been identified without the novel use of spatially specific fall data.
跌倒已成为伤害和意外死亡的主要原因，尤其是在老年人中。老年人行人跌倒的环境风险因素的证据可以支持对老年人友好的城市设计，并有助于减少行人跌倒的发生率，支持老年人户外活动的便利性。然而，对行人跌倒发生环境的调查往往受到其对参与者回忆和自我报告信息的依赖的阻碍。我们确定了在新西兰两年期间（2016-2018 年）由救护车接送的成年人在道路或街道上发生跌倒的地点，并将这些地点与一系列社会（如贫困）和环境（如坡度、绿地）风险因素联系起来。我们使用了三种类型的分析：跌倒率的描述性分析、评估患者跌倒后是否被送往医院的逻辑回归分析，以及小区域行人跌倒的负二项式回归分析。我们发现，不同年龄组跌倒地点周围的建筑环境存在一些差异。与年轻年龄组相比，老年人在家附近的跌倒率较高，附近有多种目的地的区域跌倒率较高。此外，我们的结果还表明，在贫困程度较高的地区，行人跌倒的发生率更高。生活在贫困地区的人跌倒的频率也更高，但这种模式更强烈的是基于跌倒地点的贫困程度，而不是家庭所在地的贫困程度。贫困地区的居民在跌倒后更不可能被送往医院。因此，我们的发现对环境和患者体验都有公平性的影响。如果没有对空间特定跌倒数据的新颖使用，这些模式是无法识别的。
