Not Falling Short

Injury Epidemiology of Falls in Iowa

Nicolas Foss, Ed.D., MS

2025-09-26

Objectives

Today we will look at…

  • injury data where injuries occurred in Iowa
  • overall statistics on falls
  • the distribution of falls across:
    • geographic areas
    • demographic groups
  • fall patient outcomes

Accessing this presentation

About the data

Source: Iowa Trauma Registry from 2020-2024.

  • Check out Trauma Data Registry for inclusion criteria.
  • The trauma registry…
    • …houses data on the most severe injuries.
    • …does not register all injuries in Iowa.
      • Iowa Hospital Association’s Inpatient Outpatient dataset = comprehensive

Overall fall statistics

In the following slides, we will review state-level fall statistics.

Falls at a glance

Year over year, since 2020, falls make up > 55% of all injury events in Iowa. Same-level falls grow rapidly.

A statistical table showing counts of fall events in Iowa 2020-2024.

What is the fall rate?

A statistical table showing counts of total injury and fall events with corresponding rates in Iowa 2020-2024.

Who falls the most?

In the upcoming slides, we will explore count data related to fall events by patient demographic characteristics.

Age Groups

A statistical table of the count of falls by 10-year age groups from 0-9 to 100+ along with sparklines showing trends by age group from 2020-2024. The groups 0-9, 40-49, 50-59, 60-69, 80-89, and 90-99 are highlighted in light yellow as they have the highest counts and mostly increasing trends year over year.

Patient Sex

A statistical table of the count of falls by patient biological sex with sparklines and 100% bar plots for each sex category.

Patient Race - All

Statistical tables showing counts of injury events by race group including the white race for each year 2020 through 2024. There is a 100% bar group showing the percent of total injury events by race group, and a sparkline graph in the last column showing the trend of count of injury events from 2020 through 2024.

Patient Race - Select

Statistical tables showing counts of injury events by race group excluding the white race for each year 2020 through 2024. There is a 100% bar group showing the percent of total injury events by race group, and a sparkline graph in the last column showing the trend of count of injury events from 2020 through 2024.

Insurance

A statistical table showing the counts per year from 2020-2024 of the number of injury events by patients' primary payment method. There is a sparkline graph and 100% bar plots in the last columns showing the trend from 2020-2024. Small counts are masked to protect patient confidentiality.

Where do we fall?

Patient outcomes

Now, we will learn more about the morbidity and mortality related to falls in Iowa.

Body regions affected

Falls disproportionately result in TBI.

A statistical table showing the body regions that are involved in fall injuries from 2020-2024, with a 100% bar chart showing proportion of total injury events and sparklines showing the trend from 2020-2024.

Trauma Team Activations

We just saw how often severe injuries happen to fall patients how often do we activate the trauma team with falls compared to non falls?

Trauma Team Activations

A statistical table showing the count of trauma team activations over the years, with overal rates for all years displayed by a bar graph, and trends of counts over the years 2020-2024 displayed by a sparkline graph.

Falls Injury Severity

A statistical table showing counts of trauma center cases by whether or not the patient had a fall or another injury as the primary external cause and their injury severity score range. Counts are pivoted by whether or not the trauma team was activated, and proportions of trauma team activations are shown by numbers and a dot plot in the Comparison column.

Survival rate overall

A statistical table showing a comparison of survival rates among fall injury cases and other injury cases in Iowa 2020-2024.

Risk adjusted mortality

Falls at times have poorer outcomes than other injuries.

A column chart by year from 2020 through 2024 of the calculated relative mortality metric, with columns colored by whether or not a given case was a fall. 95% confidence intervals are visualized as errorbars with whiskers indicating the estimated error.

Risk adjusted mortality, digging deeper

A deeper dive.

A statistical table using data from 2020 through 2024 showing the calculated relative mortality metric by probability of survival groups. The start and endpoints for each bin are shown for 8 groups, along with the total alive, total dead, total patients, and the predicted survivors and predicted deaths for each bin. The last column is a horizontal bar graph visualizing the relative mortality metric estimation.

A job well done

  • From 2020-2024, we expected 2,146 deaths.
  • We observed 1,374 deaths
  • Overall, Iowa trauma centers saved 772 fall patients that were predicted to die from 2020-2024.

Takeaways

  • Falls as a mechanism of injury are increasing rapidly in Iowa
    • Among age groups 50+, females, white/black individuals
  • Falls affect specific areas of the state most in 2024
    • Namely, the southwest, central/south, east, and southeast areas.

Takeaways (continued)

  • Falls are not triaged as aggressively in trauma centers, and warrant more attention
  • Apprx. 4% of the Iowa trauma patient population accounts for ~ 10% of all injury events
    • This is a group that gets injured frequently (reinjury), and is a prime target for prevention efforts.

Analyses

At BEMTS, we have been hard at work creating open source software that benefits Iowans and other jurisdictions.

GitHub Page {traumar} package page

Questions?

Thanks!

Nicolas Foss, Ed.D., MS

Epidemiologist

Bureau of Emergency Medical and Trauma Services

Bureau of Health Statistics

Division of Public Health > Iowa HHS

C: 515.985.9627 || E: nicolas.foss at hhs.iowa.gov