Key points are not available for this paper at this time.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Wang et al. (Fri,) studied this question.