上海市城乡老年人跌倒的流行病学特征

目的 了解老年人跌倒的流行病学特征及城乡差异，为有针对性的老年人跌倒预防和干预提供证据支持。方法 2017年1－3月先后对上海市7个城市社区和6个农村社区方便抽取的≥60岁常住老年人进行问卷调查，了解老年人跌倒现状、流行病学特征，分析老年人跌倒的性别和城乡差异。结果 共调查城市老年人3 386人，其中441人（13.0%）发生跌倒，261人（7.7%）发生跌伤；共调查农村老年人2 826人，其中320人（11.3%）发生跌倒，169人（6.0%）发生跌伤；城市和农村老年女性的跌倒风险均较男性高，OR值（95% CI）分别为1.62（1.42～1.86）、1.16（1.38～1.98），而跌伤风险差异无统计学意义。与城市相比，农村老年人的跌倒和跌伤风险合计均较低，OR值（95% CI）分别为0.86（0.73～0.99）、0.74（0.56～0.99），其中男性老年人跌倒风险较低、女性老年人跌伤风险较低，OR值（95% CI）分别为0.68（0.51～0.90）、0.66（0.47～0.93）。老年人的跌倒地点主要为家中，城市老年人跌倒发生在上下楼梯时的比例较高，农村则在干农活过程中的比例较高，>60%的老年人跌倒发生时有环境因素，以地面较滑和地面不平为主，跌伤中骨折的发生比例较高，城市骨折发生89人次（28.2%），农村为64人次（36.1%）。结论 上海市老年人跌倒风险存在性别和城乡差异，宜根据老年人跌倒发生特征开展有针对性的干预。

Epidemiologic characteristics of fall in the elderly in urban and rural areas in Shanghai

Objective To understand the epidemiologic characteristics of fall in the elderly in Shanghai, as well as the differences between urban and rural areas, and provide evidence for targeted fall prevention and intervention. Methods From January to March in 2017, a questionnaire survey was conducted in the elderly aged 60 or above selected from 7 urban communities and 6 rural communities in Shanghai to understand the epidemiologic characteristics of fall in the elderly and analyze the gender and urban-rural differences. Results In urban area, a total of 3 386 elderly people were surveyed, in whom 441 (13.0%) had fall and 261 (7.7%) were injured after fall. In rural area, a total of 2 826 elderly people were surveyed, in whom 320 (11.3%) had fall and 169 (6.0%) were injured after fall. Fall risk in women were higher than that in men in both urban and rural areas with OR of 1.62 (95%CI:1.42-1.86) and 1.16 (95%CI:1.38-1.98) respectively, but the differences of fall related injury were not significant. Compared with urban areas, fall risk and fall related injury risk were both lower in rural areas with OR of 0.86 (95%CI:0.73-0.99) and 0.74 (95%CI:0.56-0.99). Compared with urban areas, men had lower risk for fall, and women had lower risk for fall related injury with OR of 0.68 (95%CI:0.51-0.90) and 0.66 (95%CI:0.47-0.93) respectively. Fall mainly occurred at home. Fall in urban area more frequently occurred on stairs, and fall in rural area more frequently occurred during farming. More than 60% of the falls had environmental risk factors. Slippery ground and uneven ground were main reasons. The incidence of fracture resulted from fall was high indicated by 89 fracture cases in urban areas (28.2%) and 64 fracture cases in rural areas (36.1%). Conclusions The risk for fall in Shanghai had gender and urban-rural differences. Targeted intervention should be conducted according to the characteristics of fall in the elderly.