Age-Period-Cohort Analysis and Prediction of Falls Disease Burden Attributable to Low Bone Mineral Density in China, 1990–2019

Objectives

This study aims to comprehensively describe and analyze the disease burden of falls attributed to low bone mineral density (BMD) in China from 1990 to 2019. Furthermore, we seek to predict the future trends of this burden from 2020 to 2030 to inform evidence-based prevention and control strategies.

Methods

Using data from the 2019 Global Burden of Disease (GBD) study, we conducted an in-depth analysis of mortality and disability-adjusted life year (DALY) trends related to falls attributed to low BMD in China from 1990 to 2019. An age-period-cohort (APC) model was employed to estimate mortality risk, accounting for age, period, and cohort effects. A Bayesian framework was utilized to project mortality and DALY rates for the period 2020–2030.

Results

From 1990 to 2019, there was a significant increase in both crude death rate (224.79%) and DALY rate (196.27%) among the Chinese population affected by falls due to low bone mineral density. The standardized death rate was higher among males compared to females; however, the standardized DALY rate remained lower than that observed among females throughout this period. Importantly, China witnessed a greater surge in deaths and DALYs compared with global figures as well as other socio-demographic index regions during this time frame. The APC model demonstrated a global change of 1.06% (95% confidence interval [CI]: 0.910–1.210) for men and 0.29% (95% CI: 0.147–0.426) for women over time. The death rate increased across all age groups for men, while it specifically increased for women aged 62.5 years and older. The risk of mortality dramatically escalates for individuals over 80 years old. Projections indicate a decline in the standardized mortality rate from falls due to low bone mineral density in both men and women in China during the period of 2020–2030; however, an increase is anticipated in the standardized DALY rate.

Conclusions

The mortality risk associated with falls due to low BMD in China is influenced by age, period, and cohort effects. Strengthening fall prevention and treatment strategies for older adults and younger birth cohorts, as well as addressing fall-related disabilities, is crucial to reducing the substantial burden posed by non-fatal falls. Targeted interventions are needed to mitigate the growing health and economic impacts of this public health issue.