Objective To explore the influencing factors of falls in the elderly and to provide evidence for the prevention of falls. Methods The study was based on a large sample of 179 141 individuals in Shanghai, with a final inclusion of 40 244 participants. Firstly, independent variables including basic demographics, living environment, health status, and lifestyle habits were selected, with falls as the dependent variable, and univariate and multivariate logistic regression analyses were conducted. Secondly, negative emotions were considered as independent variables, and multivariate logistic regression analysis was performed. Results The fall incidence rate in the elderly within 90 days was 19.55%. Living alone (fall within 30 days: OR=1.161, 95%CI:1.051-1.282; fall between 31-90 days: OR=1.173, 95%CI: 1.070-1.287), unclean living environment (OR=1.775, 95%CI:1.331-2.367; OR=1.117, 95%CI: 1.037-1.203), having ≥3 chronic diseases (OR=2.024, 95%CI: 1.763-2.322; OR=2.089,95%CI: 1.835-2.379), using urine or stool pads (OR=1.581, 95%CI: 1.351-1.850; OR=1.445, 95%CI: 1.239-1.685), and low frequency of outdoor activities (occasional outdoor activitie: OR=1.458, 95%CI: 1.171-1.816; OR=1.359, 95%CI: 1.114-1.658;rarely going out: OR=2.084, 95%CI: 1.673-2.596; OR=2.053, 95%CI: 1.682-2.506) were identified as risk factors for falls within 30 days and 31 to 90 days. Advanced age (70-79 years: OR=1.179, 95%CI: 1.063-1.308; 80 years and above: OR=1.159, 95%CI: 1.040-1.292), abnormal vision (OR=1.235, 95%CI: 1.079-1.414), and needing assistance with household chores (partially completed by others: OR=1.572, 95%CI: 1.139-2.169; fully completed by others: OR=1.649, 95%CI: 1.269-2.143)were risk factors for falls within 30 days. There was no collinearity between the independent variables. Compared with those who did not feel negative emotions, the elderly who frequently felt fatigued had a lower risk of falling (fall within 30 days: OR=0.886, 95%CI: 0.811-0.968; fall between 31-90 days: OR=0.900, 95%CI: 0.828-0.977), while the elderly who frequently felt angry had a higher risk of falling (fall within 30 days: OR=1.491, 95%CI: 1.248-1.782; fall between 31-90 days: OR=1.270,95%CI: 1.067-1.513). Conclusion Elderly individuals living with others, maintaining a clean and tidy indoor environment, having a flat and clutter-free floor, and maintaining a good emotional state have a reduced risk of falling. For elderly individuals with relatively good activities of daily living (ADL) and cognitive function, it is advisable to encourage appropriate outdoor activities and engage in moderate-intensity and frequency physical activities to prevent falls.