Kou Wenkai, Ye Suni, Chen Xuerui, Huang Jing, Shi Sailong, Qiu Peiyuan
/ （ 610041） Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 Jan 20;56(1):230-238. doi: 10.12182/20250160510.
To investigate the transition intensity and transition probabilities of fall states among middle-aged and older adults in China, and to assess the impact of potential risk factors on falls.
We utilized in the study data from the China Health and Retirement Longitudinal Study (CHARLS) and employed a multi-state Markov model (MSM) to analyze the transition intensity and probabilities between states of no falls or falls without treatment, falls requiring treatment, and death.
A total of 14722 participants were enrolled, with a mean age of (59.4 years ± 9.7 years), and 47.9% were male. The median follow-up period was 9 years (interquartile range [IQR], 7-9 years). At baseline, 12381 participants (84.1%) reported no falls or falls without treatment, while 2341 (15.9%) reported falls requiring treatment. Participants who experienced falls requiring treatment within one follow-up cycle had a 55.2% probability of not falling again or only falling without treatment in the subsequent two years, a 37.6% probability of continuing to experience falls requiring treatment, and a 7.2% probability of death. The risk of transitioning from a state of no falls or falls without treatment to falls requiring treatment increased by 8.6% for every 5-year increase in age. The risk was 35.1% higher for females compared to males. Rural residents had a 10.1% higher risk. Those who were divorced, separated, widowed, or never married had a 20.7% higher risk. Higher degrees of physical function impairment were associated with an increased risk. Depressive symptoms increased the risk by 31.6%. Having one chronic disease raised the risk by 9.6%, while multimorbidity led to a 28.8% increase in risk.
According to the findings of the study, falls are a dynamic process and emphasis should be given to fall prevention for older adults, individuals with a history of fall-related medical visits, those living alone, those with impaired physical function, and those with depressive symptoms.
探讨中国中老年人群跌倒状态的转变强度和转变概率，并评估潜在风险因素对跌倒的影响。
我们在研究中使用了中国健康与养老追踪调查（CHARLS）的数据，并采用多状态马尔可夫模型（MSM）分析无跌倒或跌倒未治疗、需要治疗的跌倒以及死亡状态之间的转变强度和概率。
共纳入14722名参与者，平均年龄为（59.4岁±9.7岁），男性占47.9%。中位随访期为9年（四分位间距[IQR]，7 - 9年）。基线时，12381名参与者（84.1%）报告无跌倒或跌倒未治疗，而2341名（15.9%）报告需要治疗的跌倒。在一个随访周期内经历需要治疗的跌倒的参与者，在随后两年内不再跌倒或仅跌倒未治疗的概率为55.2%，继续经历需要治疗的跌倒的概率为37.6%，死亡概率为7.2%。年龄每增加5岁，从无跌倒或跌倒未治疗状态转变为需要治疗的跌倒的风险增加8.6%。女性的风险比男性高35.1%。农村居民的风险高10.1%。离婚、分居、丧偶或未婚者的风险高20.7%。较高程度的身体功能损害与风险增加相关。抑郁症状使风险增加31.6%。患有一种慢性病使风险增加9.6%，而多病共存则使风险增加28.8%。
根据研究结果，跌倒是一个动态过程，应重视对老年人、有跌倒相关就诊史的个体、独居者、身体功能受损者以及有抑郁症状者的跌倒预防。
