Wang Lang, Mi Yushuai, Zhu Xianglin, Liu Ziping, Liu Junjian, Zhao Cheng, Zhao Shijun, Liang Hao, Zhang Jie, Gao Tian, Ding Yinlu
Department of Gastrointestinal Surgery, The Second Qilu Hospital of Shandong University, Jinan, 250033, Shandong, PR China.
Department of Emergency Medical Center, The Second Qilu Hospital of Shandong University, Jinan, 250033, Shandong, PR China.
Aging Clin Exp Res. 2025 Nov 14;37(1):324. doi: 10.1007/s40520-025-03210-5.
Declining estrogen in perimenopausal women reduces bone mineral density and increases bone fragility, elevating fall and fracture risk. This presents major challenges for patients and society, yet prior studies lack systematic analysis of this population. This study is the first to utilize mortality and disability-adjusted life years (DALYs) related to falls among perimenopausal women from the Global Burden of Disease (GBD) 2021 database, and to conduct a comprehensive and systematic analysis of the evolving burden of falls in perimenopausal women from 1990 to 2021, as well as to project trends through 2050. This study offers key guidance for optimizing healthcare resource allocation, enhancing patient management, and developing targeted prevention and intervention strategies.
This study used GBD 2021 data to systematically analyze fall-related mortality, DALYs, age-standardized rates (ASRs), and estimated annual percentage change (EAPC) among perimenopausal women, examining their associations with the Socio-demographic Index (SDI) at global, regional, and national levels. Joinpoint regression, decomposition, health inequality, and frontier analyses quantified trends, identified factors, and assessed disparities. This study also explored fall risk factors and utilized the Bayesian Age-Period-Cohort (BAPC) model to project global trends in fall burden among perimenopausal women from 2022 to 2050.
Between 1990 and 2021, global mortality attributable to falls among perimenopausal women surged by 116.99% (from 1.67 to 3.63 per 100,000), while DALYs increased by 38.31% (from 116.50 to 188.85 per 100,000). In contrast, age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined by 7.00% (EAPC = - 0.30) and 14.62% (EAPC = - 0.56), respectively. Decomposition analysis identified population growth as the predominant contributor to the escalation in mortality (162.91%), while epidemiological changes were the main reason for the reduction (- 63.63%). Marked heterogeneity was observed across SDI strata: low-middle SDI regions exhibited the steepest rise in mortality (138.00%), whereas high-SDI regions achieved the most pronounced reduction in ASMR (- 21.18%). Notably, high-income North America experienced an 106.62% increase in ASMR. The 50-54-year age cohort consistently represented the highest global burden, with low bone mineral density emerging as the principal risk factor. Projections to 2050 suggest ongoing declines in ASMR and ASDR, yet the absolute burden is expected to remain elevated due to persistent demographic expansion.
Between 1990 and 2021, the global burden of falls among perimenopausal women has exhibited a persistent upward trend, and projections indicate that this burden will likely remain at a high level in the future. This alarming situation underscores the urgent need for targeted interventions. Identifying key risk factors for falls in perimenopausal women is essential for guiding the allocation of public health resources and formulating precise intervention strategies. It is imperative to implement nationwide, cost-effective measures, such as osteoporosis and fall risk screening, the promotion of exercise programs that enhance muscle strength and balance, and, where appropriate, consideration of pharmacological interventions (such as estrogen) to reduce fall risk. This intervention will significantly reduce the risk of falls and associated burdens among perimenopausal women.
围绝经期女性雌激素水平下降会降低骨密度，增加骨骼脆性，从而提高跌倒和骨折风险。这给患者和社会带来了重大挑战，但此前的研究缺乏对这一人群的系统分析。本研究首次利用全球疾病负担（GBD）2021数据库中与围绝经期女性跌倒相关的死亡率和伤残调整生命年（DALYs），对1990年至2021年围绝经期女性跌倒负担的演变进行全面系统分析，并预测至2050年的趋势。本研究为优化医疗资源分配、加强患者管理以及制定针对性的预防和干预策略提供了关键指导。
本研究使用GBD 2021数据，系统分析围绝经期女性的跌倒相关死亡率、DALYs、年龄标准化率（ASRs）和估计年百分比变化（EAPC），并在全球、区域和国家层面研究它们与社会人口指数（SDI）的关联。采用Joinpoint回归、分解分析、健康不平等分析和前沿分析来量化趋势、识别因素并评估差异。本研究还探讨了跌倒风险因素，并利用贝叶斯年龄-时期-队列（BAPC）模型预测2022年至2050年围绝经期女性全球跌倒负担的趋势。
1990年至2021年期间，围绝经期女性全球跌倒归因死亡率激增116.99%（从每10万人1.67例增至3.63例），而DALYs增加了38.31%（从每10万人116.50例增至188.85例）。相比之下，年龄标准化死亡率（ASMR）和年龄标准化DALY率（ASDR）分别下降了7.00%（EAPC = -0.30）和14.62%（EAPC = -0.56）。分解分析表明，人口增长是死亡率上升的主要因素（162.91%），而流行病学变化是死亡率下降的主要原因（-63.63%）。在SDI各阶层中观察到明显的异质性：中低SDI地区的死亡率上升最为显著（138.00%），而高SDI地区的ASMR下降最为明显（-21.18%）。值得注意的是，高收入的北美地区ASMR上升了106.62%。50 - 54岁年龄组一直代表着最高的全球负担，低骨密度成为主要风险因素。到2050年的预测表明，ASMR和ASDR将持续下降，但由于人口持续增长，绝对负担预计仍将升高。
1990年至2021年期间，围绝经期女性全球跌倒负担呈持续上升趋势，预测表明未来这一负担可能仍将处于较高水平。这种令人担忧的情况凸显了针对性干预的迫切需求。识别围绝经期女性跌倒的关键风险因素对于指导公共卫生资源分配和制定精确的干预策略至关重要。必须在全国范围内实施具有成本效益的措施，如骨质疏松症和跌倒风险筛查、推广增强肌肉力量和平衡能力的运动项目，并在适当情况下考虑药物干预（如雌激素）以降低跌倒风险。这种干预将显著降低围绝经期女性跌倒及相关负担的风险。
