INTRODUCTION

Falls are a leading cause of injury-related morbidity and mortality among older adults worldwide [1,2]. Each year, approximately one-third of community-dwelling adults aged ≥65 years experience at least 1 fall, and the risk increases substantially with advancing age [3,4]. Fall-related injuries often result in fractures, head injuries, and other severe conditions that require hospitalization and may lead to long-term disability or death [5,6]. The healthcare costs associated with these injuries are substantial and are projected to increase as populations age [7].

Korea is experiencing rapid population aging, and the proportion of adults aged ≥65 years was projected to exceed 20% by 2025 [8]. The 14th Korea National Injury Statistics Report indicated that falls/slips accounted for 515 124 hospitalizations in 2022, representing approximately 50% of all injury-related hospitalizations; older adults accounted for a disproportionate share of this burden [9]. Existing studies of fall-related injuries in Korea have predominantly relied on single data sources to characterize injury burden [6,10–12].

However, fall-related injuries involve a multi-stage healthcare utilization process spanning emergency medical services (EMS) dispatch, emergency department (ED) visits, hospitalizations, and deaths. The age-specific distribution of burden may differ across these stages. Notably, age groups with similar ED visit frequencies may show markedly different hospitalization and mortality patterns, suggesting that single-stage indicators may not capture the full burden of fall-related injuries. In addition, most studies have classified older adults as a single group, such as ≥65 years or ≥70 years, thereby precluding examination of differences between young-old and old-old adults [13].

Recent research indicates that frailty accumulates rapidly around age 75, leading to disproportionately large health consequences from identical external insults [14]. Thus, age-stratified analysis distinguishing young-old adults (aged 65–74 years) from old-old adults (aged ≥75 years) may reveal important differences in fall-related injury burden that are masked when older adults are analyzed as a homogeneous group.

This study aimed to describe the healthcare burden of fall-related injuries across 5 age groups using multiple national data sources. By reorganizing data from the national report by age group and healthcare stage, rather than by data source as in the original report, this study provides a crosswalk comparison of age-specific burden distribution patterns that are not directly available in the national report. We also calculated ED admission rates within the National Emergency Department Information System (NEDIS) as a methodologically valid single-source indicator.

METHODS

Study Design

This descriptive epidemiological study examined the healthcare burden of fall-related injuries across multiple stages of care in Korea. In this study, the term “healthcare stages” refers to distinct, independently measured population-level indicators of healthcare utilization—EMS dispatches, ED visits, hospitalizations, and deaths—rather than sequential transitions within individual patient trajectories. This usage is consistent with population-level injury surveillance frameworks, in which aggregate indicators at each level of healthcare contact serve as independent markers of injury burden [13,15]. These indicators do not represent an individual-level care cascade because each data source captures a different population with a different sampling frame.

Data Sources

We used data from the 14th Korea National Injury Statistics Report [9], which compiles injury-related statistics from 5 national data sources: (1) 119 Emergency Medical Services Registry: This database captures nationwide ambulance dispatches by the National Fire Agency’s 119 EMS system and records injury mechanisms and patient demographic characteristics for emergency transports. It reflects the prehospital stage of healthcare utilization. Aggregate statistics are maintained by the National Fire Agency and are publicly available through the National Fire Agency statistical portal (https://www.nfa.go.kr) and annual statistical yearbooks. (2) NEDIS: This system collects clinical and administrative data from all designated emergency medical institutions nationwide, including diagnosis codes, disposition data (admission, discharge, or death), and patient demographic characteristics. It reflects the ED visit stage and also provides within-source information on subsequent admission and in-hospital outcomes. NEDIS is operated by the National Emergency Medical Center (NEMC); aggregate statistics and annual reports are accessible through the NEMC statistical portal (https://e-medis.nemc.or.kr) and the e-Gen portal (https://www.e-gen.or.kr). (3) Korea National Hospital Discharge In-depth Injury Survey: This nationally representative sample survey includes patients discharged from approximately 170 hospitals with ≥100 beds. Sampling weights are applied to produce national estimates. It reflects the hospitalization stage independently of NEDIS. Estimates with a relative standard error ≥25% should be interpreted with caution. The Korea Disease Control and Prevention Agency (KDCA) conducts the survey annually; aggregate statistics and reports are accessible through the KDCA National Injury Information portal (https://www.kdca.go.kr/injury) and the Korean Statistical Information Service (KOSIS; https://kosis.kr). (4) Cause-of-death statistics (Statistics Korea): This complete enumeration of all deaths is based on vital registration, with causes of death coded using the International Classification of Diseases, 10th revision (ICD-10). It reflects injury-related mortality at the population level. Statistics Korea produces the data, which are publicly accessible through KOSIS (https://kosis.kr). (5) Community-based Severe Trauma Survey: This registry captures patients with an Injury Severity Score ≥16 or prehospital cardiac arrest/death who were transported by ambulance to emergency medical institutions. The KDCA conducts the survey; aggregate statistics are published in the annual Korea National Injury Statistics Report [9] and made available through the KDCA National Injury Information portal (https://www.kdca.go.kr/injury).

Case Definition

In NEDIS, the hospital discharge survey, and cause-of-death statistics, fall-related injuries were defined using ICD-10 external cause codes W00–W19. In the EMS registry and severe trauma registry, falls were identified according to each source’s injury mechanism classification, specifically the “falls/slips” category. Because case definitions varied slightly across data sources, the findings should be interpreted with this limitation in mind.

Study Population and Age Stratification

Five age groups were defined according to the original classification used in the appendix tables of the 14th Korea National Injury Statistics Report [9]: preschool children (0–6 years), school-age children and adolescents (7–18 years), working-age adults (19–64 years), young-old adults (65–74 years), and old-old adults (≥75 years). These age categories were selected to ensure exact correspondence between case counts and population denominators and to eliminate the risk of age-group misclassification. This classification also enables comparison between young-old and old-old adults, which is increasingly recognized as clinically meaningful in geriatric injury research [14].

Statistical Analysis

Age-specific crude rates per 100 000 population were calculated using 2022 mid-year registered population data from Statistics Korea [16]. The population denominators were 2 295 641 for ages 0–6 years, 5 556 040 for ages 7–18 years, 34 396 924 for ages 19–64 years, 5 235 780 for ages 65–74 years, and 3 774 764 for ages ≥75 years, for a total of 51 259 149. For hospitalization rates derived from the Korea National Hospital Discharge In-depth Injury Survey, case counts were national estimates weighted according to the survey sampling design to represent the total hospitalized population nationwide. These weighted estimates were then divided by the total mid-year registered population to yield population-level crude rates. Because the numerator, defined as the weighted estimate of hospitalized cases, and the denominator, defined as the total registered population, were derived from different data sources, these rates should be interpreted as approximate population-level indicators rather than direct measures of hospitalization incidence.

The proportion of ED visits resulting in hospital admission, hereafter referred to as the ED admission rate, was calculated within the NEDIS database. This within-source metric avoids the methodological artifacts associated with cross-database ratio calculations. Because the hospitalization data source is independent of NEDIS, cross-source ratios were not calculated.

Ethics Statement

This study used publicly available aggregate statistics and did not involve individual patient data. According to institutional and national guidelines, institutional review board approval was not required.

RESULTS

Overall Burden of Fall-related Injuries in 2022

In 2022, fall-related injuries resulted in 241 830 EMS dispatches (472 per 100 000), 373 123 ED visits (728 per 100 000), an estimated 515 124 hospitalizations (1005 per 100 000), 2702 deaths (5.3 per 100 000), and 3299 severe trauma cases (6 per 100 000) (Table 1).

Age-specific Rates by Healthcare Stage

ED visit rates for fall-related injuries were highest among children aged 0–6 years (2312 per 100 000) and adults aged ≥75 years (2121 per 100 000), and rates were comparable between these 2 groups (Table 1 and Figure 1A). Adults aged 65–74 years had a higher rate (873 per 100 000) than working-age adults (460 per 100 000), but their rate remained substantially lower than that among adults aged ≥75 years.

Hospitalization rates showed a steep age gradient. The rate among adults aged ≥75 years (4852 per 100 000) was 2.6 times higher than that among adults aged 65–74 years (1832 per 100 000) and 7.9 times higher than that among working-age adults (614 per 100 000). Adults aged ≥75 years accounted for 35.6% of all fall-related hospitalizations (183 145 of 515 124); when combined with adults aged 65–74 years (95 942), adults aged ≥65 years accounted for 54.2%.

Fall-related deaths were heavily concentrated among older adults. The rate among adults aged ≥75 years (32.5 per 100 000) was 3.0 times higher than that among adults aged 65–74 years (11.0 per 100 000). Adults aged ≥75 years accounted for 45.4% of all fall-related deaths (Figure 2).

Within-national Emergency Department Information System Emergency Department Admission Rate

Within the NEDIS database, the proportion of fall-related ED visits resulting in hospital admission showed a consistent age gradient (Table 2 and Figure 1B): 2.6% among children aged 0–6 years, 7.8% among those aged 7–18 years, 17.5% among those aged 19–64 years, 32.1% among those aged 65–74 years, and 42.9% among those aged ≥75 years. The ED case fatality rate also increased with age, from 0.02% among children aged 0–6 years to 2.04% among adults aged ≥75 years.

Between 2018 and 2022, the fall/slip hospitalization rate among adults aged ≥70 years rose by 23.1%, peaking in 2022 (Figure 3, Supplemental Material 1).

DISCUSSION

This study characterized the distribution of fall-related injury burden across healthcare stages among 5 age groups in Korea. The findings indicate that the burden among adults aged ≥75 years was disproportionately concentrated at the hospitalization and mortality stages. Beyond reorganizing existing national data, this study provides 3 analytic contributions: a crosswalk comparison of age-specific burden across multiple independently measured healthcare stages, a within-NEDIS ED admission rate as a methodologically valid single-source indicator, and a direct comparison between young-old and old-old adults that highlights clinically meaningful differences masked in conventional single-group analyses.

The most notable finding is that ED visit frequency alone does not capture the full downstream burden of fall-related injuries. Although children aged 0–6 years and adults aged ≥75 years had comparable ED visit rates, the within-NEDIS ED admission rate differed markedly between the groups (2.6 vs. 42.9%). Falls in young children typically result in minor injuries, whereas falls in older adults more often lead to fractures, head trauma, and other conditions requiring hospitalization [5,17]. This difference is attributable in part to age-related biological vulnerability, including decreased bone density, sarcopenia, and anticoagulant use [14,18].

The steep gradient between young-old (65–74 years) and old-old (≥75 years) adults cannot be explained by a proportional increase in fall frequency alone. The ratios for hospitalization rates (2.6-fold) and mortality rates (3.0-fold) exceeded the ratio for ED visit rates (2.4-fold), suggesting that the probability of severe outcomes per fall event increases disproportionately after age 75. Clegg et al. [14] reported that frailty accumulates rapidly after age 75, leading to disproportionately large health consequences from identical external insults. Our findings provide population-level evidence consistent with this framework.

The within-NEDIS ED admission rate increased monotonically across age groups: from 2.6% among children aged 0–6 years to 7.8%, 17.5%, 32.1%, and 42.9% in successively older age groups. This gradient is methodologically noteworthy because previous studies have been criticized for calculating ratios using counts from different data sources. By using a within-source metric, this indicator avoids such artifacts while indirectly reflecting age-related differences in fall injury severity.

These findings suggest that reliance on ED-based surveillance alone for fall prevention may underestimate the burden among the oldest adults. The observed patterns support consideration of inpatient-focused approaches and post-discharge transition-of-care strategies [19–22]. However, because this study did not directly evaluate intervention effectiveness, further research is needed to determine optimal intervention models for this population. In Korea, the enactment of the Injury Prevention and Management Act in 2024 [23] provides a policy framework within which such evidence could inform resource allocation decisions.

Several limitations should be considered. First, this study analyzed aggregate population-level statistics; individual patient trajectories were not tracked, and ecological fallacy is possible. Second, case definitions varied across data sources, and hospitalization counts from the discharge survey were independent of NEDIS ED visit counts. Third, our age classification (0–6, 7–18, 19–64, 65–74, and ≥75 years) was based on the original data source categories and may not align with conventional geriatric age thresholds. Fourth, rates were crude, and age-standardized rates were not calculated. Fifth, the hospitalization rates derived from the Korea National Hospital Discharge In-depth Injury Survey were calculated using a weighted sample-based numerator and a population-based denominator. Because this dual-data-source approach may affect absolute rate estimates, these rates should be interpreted as approximate population-level indicators.

These findings suggest that future research and policy development on fall prevention in aging populations should account for the downstream burden beyond ED visits.

Supplemental Materials

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Acknowledgements

None.

Author Contributions

Conceptualization: Yoo J. Data curation: Kim M, Yoo J. Formal analysis: Kim M. Funding acquisition: None. Methodology: Yoo J, Song K. Writing – original draft: Kim M. Writing – review & editing: Kim T, Song K, Lee SH, Yoo J.

Figure 1

Age-specific fall-related injury rates and ED admission rates by age group in Korea, 2022. (A) Stage-specific rates per 100 000 population. (B) Within-NEDIS ED admission rates, showing a consistent age-related increase from 2.6% to 42.9%. EMS, emergency medical services; ED, emergency department; NEDIS, National Emergency Department Information System.

Figure 2

Comparison of fall-related injury burden between young-old (65–74 years) and old-old (≥75 years) adults in Korea, 2022. (A) Healthcare utilization rates per 100 000 population for EMS dispatches, ED visits, and hospitalizations. (B) Fall-related mortality rate per 100 000 population, shown on a separate scale. EMS, emergency medical services; ED, emergency department; NEDIS, National Emergency Department Information System.

Figure 3

Trends in fall-related injury indicators among adults aged ≥70 years in Korea, 2018–2022. (A) Falls/slips hospitalization rate per 100 000 population; shaded area, coronavirus disease 2019 (COVID-19) period (2020–2021). (B) Falls hospitalization rate and all-injury EMS, ED, and mortality rates, with mortality on a secondary axis; percentages denote the change from 2018 to 2022. EMS, emergency medical services; ED, emergency department.

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