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Estimating the Economic Burden Related to Older Adult Falls by State

Haddad, Yara K. PharmD, MPH; Bergen, Gwen PhD, MPH, MS; Florence, Curtis S. PhD

Journal of Public Health Management and Practice: March/April 2019 - Volume 25 - Issue 2 - p E17–E24
doi: 10.1097/PHH.0000000000000816
Research Reports: Research Full Report

Objective: Unintentional falls in older adults (persons 65 years of age and older) impose a significant economic burden on the health care system. Methods for calculating state-specific health care costs are limited. This study describes 2 methods to estimate state-level direct medical spending due to older adult falls and explains their differences, advantages, and limitations.

Design: The first method, partial attributable fraction, applied a national attributable fraction to the total state health expenditure accounts in 2014 by payer type (Medicare, Medicaid, and private insurance). The second method, count applied to cost, obtained 2014 state counts of older adults treated and released from an emergency department and hospitalized because of a fall injury. The counts in each state were multiplied by the national average lifetime medical costs for a fall-related injury from the Web-based Injury Statistics Query and Reporting System. Costs are reported in 2014 US dollars.

Setting: United States.

Participants: Older adults.

Main Outcome Measure: Health expenditure on older adult falls by state.

Results: The estimate from the partial attributable fraction method was higher than the estimate from the count applied to cost method for all states compared, except Utah. Based on the partial attributable fraction method, in 2014, total personal health care spending for older adult falls ranged from $48 million in Alaska to $4.4 billion in California. Medicare spending attributable to older adult falls ranged from $22 million in Alaska to $3.0 billion in Florida. For the count applied to cost method, available for 17 states, the lifetime medical costs of 2014 fall-related injuries ranged from $68 million in Vermont to $2.8 billion in Florida.

Conclusions: The 2 methods offer states options for estimating the economic burden attributable to older adult fall injuries. These estimates can help states make informed decisions about how to allocate funding to reduce falls and promote healthy aging.

Emory University, Rollins School of Public Health, Atlanta, Georgia (Dr Haddad); and Division of Unintentional Injury Prevention (Drs Haddad and Bergen) and Division of Analysis, Research and Practice Integration (Dr Florence), National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Correspondence: Yara K. Haddad, PharmD, MPH, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F-62, Atlanta, GA 30341, USA (

The authors thank Likang Xu, MD, MS (Mathematical Statistician), and Elizabeth Burns, MPH (Health Scientist), with the National Center for Injury Prevention and Control for their assistance and guidance with coding and analysis of Healthcare Cost and Utilization Project data.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

None of the authors has relevant financial interests, activities, relationships, or affiliations, or other potential conflicts of interest to report.

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