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Article(id=1321170728641216812, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170608034009636, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146907, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736352000000, receivedDateStr=2025-01-09, revisedDate=1745769600000, revisedDateStr=2025-04-28, acceptedDate=1753286400000, acceptedDateStr=2025-07-24, onlineDate=1792921247873, onlineDateStr=2026-10-25, pubDate=1765296000000, pubDateStr=2025-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921247873, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921247873, creator=13701087609, updateTime=1792921247873, updator=13701087609, issue=Issue{id=1321170608034009636, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='12', pageStart='1409', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1765296000000', pubDateStr='2025-12-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921219118, creator='13701087609', updateTime=1793011150268, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1321547806687474583, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170608034009636, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1321547806687474584, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170608034009636, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1445, endPage=1449, ext={EN=ArticleExt(id=1321170728880292141, articleId=1321170728641216812, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Incidence and influencing factors for moderate and severe fall-related injuries among older adults in Guangzhou: an analysis of injury surveillance data from 2015 to 2021, columnId=1321170608730264101, journalTitle=Chinese Journal of Public Health, columnName=Special Report—Promoting Healthy Aging and Improving the Quality of Life for the Elderly, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the incidence and influencing factors of moderate and severe fall-related injuries among the elderly in Guangzhou, Guangdong, China, thus informing evidence-based interventions for fall prevention in the elderly population.

Methods

To analyze the incurrence of moderate and severe fall-related injuries and identify influencing factors among the elderly patients, we collected data from 13 898 injury surveillance reports between January 1, 2015 and December 31, 2021 across four National Injury Surveillance Sentinel hospitals in Guangzhou.

Results

moderate and severe injuries accounted for 38.53% (n = 5 355) of cases. Multivariate unconditional logistic regression analysis identified the following risk factors: female, non-local household registration, age ≥ 70 years, history of falls, and activity-specific hazards emerged during walking (OR=1.118) and essential life activities, particularly in unspecified locations. Autumn occurrence and road/street environments of falls were the protective factors.

Conclusions

The incidence of moderate and severe fall-related injuries among elderly patients in Guangzhou is high. Key influencing factors include gender, age, household registration, history of falls, seasons, activities, and locations.

, authors=Tingyuan HUANG1, Weiquan LIN1, Faju QIN1, Xinyi YANG2, Juan QI1, Jichuan SHEN1, Boheng LIANG1, authorsList=Tingyuan HUANG, Weiquan LIN, Faju QIN, Xinyi YANG, Juan QI, Jichuan SHEN, Boheng LIANG, authorCompany=null, correspAuthors=Weiquan LIN, Boheng LIANG, authorNote=null, correspAuthorsNote=
LIN Weiquan, E-mail:
LIANG Boheng, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321170729350054192, articleId=1321170728641216812, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=广州市跌倒/坠落老年患者中度及重度损伤发生情况及影响因素：基于2015—2021年伤害监测数据分析, columnId=1321170608898036263, journalTitle=中国公共卫生, columnName=专题报道——守护老年健康，提升生命质量, runingTitle=null, highlight=null, articleAbstract=
目的

了解广东省广州市跌倒/坠落老年患者中度及重度损伤发生情况及影响因素，为制定老年人跌倒/坠落的干预措施提供参考依据。

方法

收集2015年1月1日—2021年12月31日广州市4家全国伤害监测哨点医院13 898例跌倒/坠落老年患者伤害监测报告卡的相关数据。分析其中度及重度损伤发生情况。并采用多因素非条件logistic回归模型分析当地跌倒/坠落老年患者中度及重度损伤发生的影响因素。

结果

广州市13 898例跌倒/坠落老年患者中，发生中度及重度损伤者5 355例，中度及重度损伤发生比例为38.53%；多因素非条件logistic回归分析结果显示，女性、年龄≥70岁、外省户籍、跌倒/坠落发生地点为其他场所、跌倒/坠落发生时活动为步行和生命活动、有跌倒/坠落史的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较高。跌倒/坠落发生季节为秋季和跌倒/坠落发生地点为公路/街道的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较低。

结论

广州市跌倒/坠落老年患者中度及重度损伤发生率较高，性别、年龄、户籍、有无跌倒/坠落史以及跌倒/坠落发生季节、发生地点、发生时活动为该地区老年患者发生中度及重度损伤的主要影响因素。

, authors=黄婷苑1, 林伟权1, *, *, 秦发举1, 杨心怡2, 祁娟1, 沈纪川1, 梁伯衡1, *, *, authorsList=黄婷苑, 林伟权, 秦发举, 杨心怡, 祁娟, 沈纪川, 梁伯衡, authorCompany=null, correspAuthors=林伟权, 梁伯衡, authorNote=

黄婷苑（1988—），副主任医师，硕士，研究方向：慢性病预防与控制

, correspAuthorsNote=
林伟权，E-mail：
梁伯衡，E-mail：
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黄婷苑（1988—），副主任医师，硕士，研究方向：慢性病预防与控制

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Comparison of incidence of moderate-to severe fall-related injuries among the elderly patients with different characteristics in Guangzhou city

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特征分类跌倒/坠落患者数/例中度及重度损伤发生数/例中度及重度损伤发生比例/%χ2值P值
性别男性5 2651 80934.3610.3740.001
女性8 6333 54641.07
年龄/岁60～695 2891 56729.63357.319<0.001
70～793 8981 52539.12
≥804 7112 26348.04
报告医院所在地城市7 4203 03040.8435.706<0.001
郊区6 4782 32535.89
户籍广州市11 3894 44939.069.3960.009
广东省其他城市1 42749934.97
外省1 08240737.62
文化程度文盲/半文盲2 7241 14437.8817.5840.001
小学5 4672 07142.00
初中3 9231 46337.29
高中/中专及以上1 78467737.95
职业农牧渔水利生产人员49715040.1739.262<0.001
离退休人员9 453379735.80
家务人员3 5001 25330.18
其他44815534.60
跌倒/坠落发生季节春季2 6901 07940.1122.568<0.001
夏季3 2761 21937.21
秋季4 4101 61036.51
冬季3 5221 44741.08
跌倒/坠落发生地点家中9 8143 92039.9451.273<0.001
公路/街道2 05664831.52
公共居住场所1 10642438.34
贸易和服务场所26410339.02
其他场所65826039.51
跌倒/坠落发生时活动休闲活动5 2611 99237.8648.26<0.001
步行3 4281 29437.75
生命活动2 9851 29943.52
家务1 73961035.08
其他活动48516032.99
饮酒史无13 8025 32438.571.5890.248
有963132.29
跌倒/坠落史无12 0724 68038.772.1730.142
有1 82667536.97
), ArticleFig(id=1321170734454522215, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170728641216812, language=CN, label=表1, caption=

广州市不同特征跌倒/坠落老年患者中度及重度损伤发生情况比较

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特征分类跌倒/坠落患者数/例中度及重度损伤发生数/例中度及重度损伤发生比例/%χ2值P值
性别男性5 2651 80934.3610.3740.001
女性8 6333 54641.07
年龄/岁60～695 2891 56729.63357.319<0.001
70～793 8981 52539.12
≥804 7112 26348.04
报告医院所在地城市7 4203 03040.8435.706<0.001
郊区6 4782 32535.89
户籍广州市11 3894 44939.069.3960.009
广东省其他城市1 42749934.97
外省1 08240737.62
文化程度文盲/半文盲2 7241 14437.8817.5840.001
小学5 4672 07142.00
初中3 9231 46337.29
高中/中专及以上1 78467737.95
职业农牧渔水利生产人员49715040.1739.262<0.001
离退休人员9 453379735.80
家务人员3 5001 25330.18
其他44815534.60
跌倒/坠落发生季节春季2 6901 07940.1122.568<0.001
夏季3 2761 21937.21
秋季4 4101 61036.51
冬季3 5221 44741.08
跌倒/坠落发生地点家中9 8143 92039.9451.273<0.001
公路/街道2 05664831.52
公共居住场所1 10642438.34
贸易和服务场所26410339.02
其他场所65826039.51
跌倒/坠落发生时活动休闲活动5 2611 99237.8648.26<0.001
步行3 4281 29437.75
生命活动2 9851 29943.52
家务1 73961035.08
其他活动48516032.99
饮酒史无13 8025 32438.571.5890.248
有963132.29
跌倒/坠落史无12 0724 68038.772.1730.142
有1 82667536.97
), ArticleFig(id=1321170734534213992, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170728641216812, language=EN, label=Tab.2, caption=

Multivariate unconditional logistic regression analysis on influencing factors of moderate and severe fall-related injuries among the elderly patients in Guangzhou

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因素比较组参照组β $ S_{\overline{x}} $Wald χ2值P值OR值95%CI
性别女性男性0.1090.0378.6890.0031.1151.037～1.198
年龄/岁70～7960～690.4330.04784.801<0.0011.5421.406～1.690
≥800.7660.048250.049<0.0012.1511.956～2.365
户籍广东省其他城市广州市−0.1140.0603.5980.0580.8920.793～1.004
外省0.1730.0696.2690.0121.1891.038～1.362
跌倒/坠落发生季节夏季春季−0.0990.0543.3150.0690.9060.814～1.008
秋季−0.1490.0518.4670.0040.8610.779～0.952
冬季0.0170.0530.1000.7511.0170.916～1.129
跌倒/坠落发生地点公路/街道家中−0.2470.06016.737<0.0010.7810.694～0.879
公共居住场所0.0080.0680.0150.9031.0080.883～1.151
贸易和服务场所0.1180.1320.7960.3721.1250.869～1.457
其他场所0.2530.0947.2420.0071.2871.071～1.548
跌倒/坠落发生时活动步行休闲活动0.1120.0504.9120.0271.1181.013～1.235
生命活动0.1980.04816.981<0.0011.2201.110～1.340
家务0.0560.0610.8330.3611.0570.938～1.192
其他活动0.0250.1140.0470.8281.0250.820～1.281
跌倒/坠落史有无0.2020.05314.321<0.0011.2241.102～1.359
), ArticleFig(id=1321170734601322857, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170728641216812, language=CN, label=表2, caption=

广州市跌倒/坠落老年患者中度及重度损伤发生情况影响因素多因素非条件logistic回归分析

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因素比较组参照组β $ S_{\overline{x}} $Wald χ2值P值OR值95%CI
性别女性男性0.1090.0378.6890.0031.1151.037～1.198
年龄/岁70～7960～690.4330.04784.801<0.0011.5421.406～1.690
≥800.7660.048250.049<0.0012.1511.956～2.365
户籍广东省其他城市广州市−0.1140.0603.5980.0580.8920.793～1.004
外省0.1730.0696.2690.0121.1891.038～1.362
跌倒/坠落发生季节夏季春季−0.0990.0543.3150.0690.9060.814～1.008
秋季−0.1490.0518.4670.0040.8610.779～0.952
冬季0.0170.0530.1000.7511.0170.916～1.129
跌倒/坠落发生地点公路/街道家中−0.2470.06016.737<0.0010.7810.694～0.879
公共居住场所0.0080.0680.0150.9031.0080.883～1.151
贸易和服务场所0.1180.1320.7960.3721.1250.869～1.457
其他场所0.2530.0947.2420.0071.2871.071～1.548
跌倒/坠落发生时活动步行休闲活动0.1120.0504.9120.0271.1181.013～1.235
生命活动0.1980.04816.981<0.0011.2201.110～1.340
家务0.0560.0610.8330.3611.0570.938～1.192
其他活动0.0250.1140.0470.8281.0250.820～1.281
跌倒/坠落史有无0.2020.05314.321<0.0011.2241.102～1.359
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黄婷苑 1 , 林伟权 1, *, * , 秦发举 1 , 杨心怡 2 , 祁娟 1 , 沈纪川 1 , 梁伯衡 1, *, *
中国公共卫生 | 专题报道——守护老年健康，提升生命质量 2025,41(12): 1445-1449
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中国公共卫生 |专题报道——守护老年健康，提升生命质量 2025 , 41 (12) : 1445 -1449
广州市跌倒/坠落老年患者中度及重度损伤发生情况及影响因素：基于2015—2021年伤害监测数据分析
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黄婷苑1, 林伟权1, *, * , 秦发举1, 杨心怡2, 祁娟1, 沈纪川1, 梁伯衡1, *, *
作者信息
  • 1广州市疾病预防控制中心，广州 510440
  • 2广州市荔湾区疾病预防控制中心，广州 510145
通讯作者:
林伟权，E-mail：
梁伯衡，E-mail：
作者简介:

黄婷苑（1988—），副主任医师，硕士，研究方向：慢性病预防与控制

Incidence and influencing factors for moderate and severe fall-related injuries among older adults in Guangzhou: an analysis of injury surveillance data from 2015 to 2021
Tingyuan HUANG1, Weiquan LIN1 , Faju QIN1, Xinyi YANG2, Juan QI1, Jichuan SHEN1, Boheng LIANG1
Affiliations
  • 1Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
  • 2Liwan District Center for Disease Control and Prevention, Guangzhou 510145, China
    • Corresponding Author:
    LIN Weiquan, E-mail:
    LIANG Boheng, E-mail:
出版时间: 2025-12-10 doi: 10.11847/zgggws1146907
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摘要
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目的

了解广东省广州市跌倒/坠落老年患者中度及重度损伤发生情况及影响因素，为制定老年人跌倒/坠落的干预措施提供参考依据。

方法

收集2015年1月1日—2021年12月31日广州市4家全国伤害监测哨点医院13 898例跌倒/坠落老年患者伤害监测报告卡的相关数据。分析其中度及重度损伤发生情况。并采用多因素非条件logistic回归模型分析当地跌倒/坠落老年患者中度及重度损伤发生的影响因素。

结果

广州市13 898例跌倒/坠落老年患者中，发生中度及重度损伤者5 355例，中度及重度损伤发生比例为38.53%；多因素非条件logistic回归分析结果显示，女性、年龄≥70岁、外省户籍、跌倒/坠落发生地点为其他场所、跌倒/坠落发生时活动为步行和生命活动、有跌倒/坠落史的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较高。跌倒/坠落发生季节为秋季和跌倒/坠落发生地点为公路/街道的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较低。

结论

广州市跌倒/坠落老年患者中度及重度损伤发生率较高，性别、年龄、户籍、有无跌倒/坠落史以及跌倒/坠落发生季节、发生地点、发生时活动为该地区老年患者发生中度及重度损伤的主要影响因素。

跌倒/坠落  /  中度及重度损伤  /  发生情况  /  影响因素  /  老年患者  /  广州市
Objective

To investigate the incidence and influencing factors of moderate and severe fall-related injuries among the elderly in Guangzhou, Guangdong, China, thus informing evidence-based interventions for fall prevention in the elderly population.

Methods

To analyze the incurrence of moderate and severe fall-related injuries and identify influencing factors among the elderly patients, we collected data from 13 898 injury surveillance reports between January 1, 2015 and December 31, 2021 across four National Injury Surveillance Sentinel hospitals in Guangzhou.

Results

moderate and severe injuries accounted for 38.53% (n = 5 355) of cases. Multivariate unconditional logistic regression analysis identified the following risk factors: female, non-local household registration, age ≥ 70 years, history of falls, and activity-specific hazards emerged during walking (OR=1.118) and essential life activities, particularly in unspecified locations. Autumn occurrence and road/street environments of falls were the protective factors.

Conclusions

The incidence of moderate and severe fall-related injuries among elderly patients in Guangzhou is high. Key influencing factors include gender, age, household registration, history of falls, seasons, activities, and locations.

falls  /  moderate and severe injuries  /  incidence  /  influencing factors  /  elderly patients  /  Guangzhou city
黄婷苑, 林伟权, 秦发举, 杨心怡, 祁娟, 沈纪川, 梁伯衡. 广州市跌倒/坠落老年患者中度及重度损伤发生情况及影响因素：基于2015—2021年伤害监测数据分析. 中国公共卫生, 2025 , 41 (12) : 1445 -1449 . DOI: 10.11847/zgggws1146907
Tingyuan HUANG, Weiquan LIN, Faju QIN, Xinyi YANG, Juan QI, Jichuan SHEN, Boheng LIANG. Incidence and influencing factors for moderate and severe fall-related injuries among older adults in Guangzhou: an analysis of injury surveillance data from 2015 to 2021[J]. Chinese Journal of Public Health, 2025 , 41 (12) : 1445 -1449 . DOI: 10.11847/zgggws1146907
正文
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中国是世界上人口老龄化速度最快的国家之一，老年人跌倒已成为一个亟待关注的公共卫生挑战[1]。研究表明，跌倒是老年人伤残和死亡的主要原因[2]。一旦发生跌倒事件，老年人有可能面临躯体损伤、心理创伤、生活质量降低，甚至死亡等后果。因此，其不仅影响老年人的身心健康，还给个人及社会带来沉重的经济负担[2–3]。张晗等[4]研究显示，我国≥60岁社区老年人跌倒发生率为14.70%，而广东省广州市社区≥65岁老年人的跌倒发生率为25.49%[5]，提示该地区老年人跌倒发生率相对较高。尽管跌倒难以完全避免，但通过深入分析导致严重跌伤的相关影响因素，并据此采取行之有效的防控措施，对于降低跌倒事件的发生具有重要意义。然而目前针对老年人跌倒/坠落损伤严重情况及其影响因素的研究较少。因此，本研究收集2015年1月1日—2021年12月31日广州市4家全国伤害监测哨点医院13 898例跌倒/坠落老年患者伤害监测报告卡的相关数据，分析其中度及重度损伤发生情况及其影响因素。旨在为制定老年人跌倒/坠落的干预措施提供参考依据。结果报告如下。
1　资料与方法
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1.1　资料来源
收集2015年1月1日—2021年12月31日广州市红十字会医院、番禺区中心医院、白云区第二人民医院和荔湾区中医医院广雅院区4家全国伤害监测哨点医院门/急诊诊断为跌倒/坠落的13 898例≥60岁老年患者伤害监测报告卡的相关数据， 排除因同一次伤害在哨点医院复诊的患者。伤害监测报告卡由监测哨点医院接诊医生或护士在诊断患者为首次伤害病例后进行填写。内容包括伤害病例人口学信息、伤害事件发生时间、地点、活动、伤害发生部位、严重程度等。
1.2　数据质量控制
报告卡需经医院专门负责人员依据《全国伤害监测工作手册》[6]质控要求进行审核，并确保在1周内上传至广州市伤害监测分析平台，然后由区、市两级疾病预防控制机构再次审核后上报至省级疾病预防控制机构。审核的重点为报卡规范性、逻辑性及是否重复报卡。为保证数据质量，各级监测工作组均按照要求定期对辖区内哨点医院的伤害监测工作开展漏报、错报调查等质量控制工作。
1.3　相关定义
（1）跌倒/坠落的定义为突发的、不自主的、非故意的体位改变而倒在地上或更低的平面[6]。（2）伤害严重程度分为轻、中和重度3级，其中轻度损伤为无明显或轻微受伤，或浅表擦伤，或轻微割伤；中度损伤指需要专业化治疗的损伤，包括骨折或需要进行缝合的损伤；重度损伤指需要立即急救或外科手术治疗的损伤，包括内出血、器官贯穿伤和血管受损等[6]。本研究重度病例较少，为提高统计效能，突出跌倒高风险群体的早期干预需求，因此将中度和重度损伤合并分析。（3）休闲活动指业余爱好、伴有娱乐成分的活动，如看电影、跳舞、参加聚会，不包括体育活动[6]。生命活动指包括吃饭、睡觉、休息、洗漱、如厕和性生活等活动[6]。（4）饮酒史由医生通过询问、闻气味、观察患者的表现推测患者的饮酒情况[6]。（5）跌倒/坠落史指在本研究数据库中存在同一患者报告的≥2次非同一伤害发生时间、地点和活动的跌倒/坠落事件[7]。
1.4　统计分析
采用SPSS 20.0统计软件进行一般描述性分析，χ2检验和多因素非条件logistic回归分析。检验水准为双侧检验α=0.05。
2　结　果
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2.1　广州市老年跌倒/坠落患者一般情况
广州市13 898例跌倒/坠落老年患者中，男性5 265例（37.88%），女性8 633例（62.12%）；年龄60～69岁5 289例（38.05%），70～79岁3 898例（28.05%），≥80岁4 711例（33.90%）；报告医院所在地为城区7 420例（53.39%），郊区6 478例（46.61%）；本市户籍11 389例（81.95%），本省外市户籍1 427例（10.26%），外省户籍1 082例（7.79%）；文化程度为文盲/半文盲2 724例（19.60%），小学5 647例（39.33%），初中3 923例（28.23%），高中/中专及以上1 784例（12.84%）；职业为农牧渔水利生产人员497例（3.58%）；离退休人员9 453例（68.02%）；家务人员3 500例（25.18%）；其他448例（3.22%）；跌倒/坠落发生时间在春季2 690例（19.36%），夏季3 276例（23.57%），秋季4 410例（31.73%），冬季3 522例（25.34%）；跌倒/坠落发生地点为家中9 814例（70.62%），公路/街道2 056例（14.79%），公共居住场所1 106例（7.96%），贸易和服务场所264例（1.90%），其他场所658例（4.73%）；跌倒/坠落发生时活动为休闲活动5 261例（37.85%），步行3 428例（24.67%），生命活动2 985例（21.48%），家务1 739例（12.51%），其他活动485例（3.49%）；跌倒/坠落发生前无饮酒史13 802例（99.31%），有饮酒史96例（0.69%）；无跌倒/坠落史12 072例（86.86%），有跌倒/坠落史1 826例（13.14%）。
2.2　广州市跌倒/坠落老年患者中度及重度损伤发生情况（表1）
广州市13 898例跌倒/坠落老年患者中，发生轻度损伤病例8 543例（61.47%），中度病例5 090例（36.62%），重度病例265例（1.91%）。中度及重度病例合并后5 355例（38.53%）；广州市不同特征跌倒/坠落老年患者比较，不同性别、年龄、报告医院所在地、户籍、文化程度、职业、跌倒/坠落发生季节、跌倒/坠落发生地点和跌倒/坠落发生时活动老年患者中度及重度损伤发生比例不同，差异均有统计学意义（均P<0.01）。
2.3　广州市跌倒/坠落老年患者中度及重度损伤发生情况影响因素多因素非条件logistic回归分析（表2）
以广州市跌倒/坠落老年患者是否发生中度及重度损伤为因变量（0=否，1=是），以性别、年龄、报告医院所在地、户籍、文化程度、职业、跌倒/坠落发生季节、跌倒/坠落发生地点、跌倒/坠落发生时活动和跌倒/坠落史共10个因素为自变量进行多因素非条件logistic回归分析。结果显示，女性、年龄≥70岁、外省户籍、跌倒/坠落发生地点为其他场所、跌倒/坠落发生时活动为步行和生命活动、有跌倒/坠落史的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较高，跌倒/坠落发生季节为秋季和跌倒/坠落发生地点为公路/街道的广州市跌倒/坠落老年患者发生中度及重度损伤的风险较低。
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本研究结果显示，广州市伤害监测哨点医院报告的跌倒/坠落老年患者中度及重度损伤发生比例为38.53%，略高于陆治名等[8]研究中报告的全国跌倒/坠落老年患者中度及重度损伤发生比例的37.21%。提示应加强广州市老年人跌倒/坠落的干预和预防控制中度及重度损伤。
本研究中，广州市跌倒/坠落老年女性患者发生中度及重度损伤的风险为老年男性患者的1.115倍（95%CI=1.037～1.198），与全人群监测中男性发生中度及重度损伤风险更大的结果相反[9]。这一差异可能源于老年女性在生理结构、肌肉力量和平衡能力等方面的特殊性，以及她们在生活中可能面临更多跌倒的风险因素，如家务劳动中的频繁弯腰、转身动作等。广州市外省户籍跌倒/坠落老年患者发生中度及重度损伤风险较高，为本市户籍老年患者的1.189倍（95%CI=1.038～1.362），这可能与外省户籍老年人对当地环境不熟悉、缺乏社会支持网络有关[10]。但仍需进一步探究其成因并采取相应的预防措施。结果提示，广州市老年跌倒防控工作应将老年女性群体，特别是外省老年人作为重点关注对象。
本研究发现，患者年龄与跌倒损伤严重程度呈显著正相关。广州市70～79岁和≥80岁跌倒/坠落老年患者发生中度及重度损伤的风险分别为60～69岁老年患者的1.542倍（95%CI=1.406～1.690）和2.151倍（95%CI=1.956～2.365）。这可能是除生理性衰老[11]外，骨骼肌肉系统和神经系统反应能力减弱等使得老年人在跌倒后无法及时调整姿势，常以头部或臀部等重要部位落地，进而增加中度及重度损伤风险。此外，老年人往往患有多种慢性病[12]，这亦使得其在跌倒时发生骨折等严重伤害的风险大大增加。
本研究中，广州市跌倒/坠落老年患者在秋季的中度及重度损伤风险为春季的0.861倍（95%CI=0.779～0.952），这可能与华南地区春季特有的“回南天”导致地面湿滑[13]以及春季传统节日活动场景复杂（如清明节需要拜山）等有关。广州市跌倒/坠落老年患者在公路/街道的中度及重度损伤风险为家中的0.781倍（95%CI=0.694～0.879），此外，在家中进行洗澡、如厕、睡觉等生命活动时跌倒/坠落的中度及重度损伤发生风险为休闲活动时的1.220倍（95%CI=1.110～1.340）。这可能与老年人在家中所处时间最长使得其放松警惕而更易忽略家中存在环境致跌危险因素有关[14]。提示今后在开展预防老年人跌倒干预时需重点关注家庭环境的适老化改造[15]，如改善照明和去除障碍物等。同时，还应加强家庭成员对老年人跌倒风险的认知，提高其预防意识和应急处理能力。
虽然在单因素分析中本研究未发现有无跌倒/坠落史老年患者中度及重度损伤比例差异有统计学意义，但既往研究表明，有无跌倒/坠落史为再跌倒的危险因子[16–17]。因此，本研究也将该因素纳入多因素分析。结果显示，有跌倒/坠落史老年患者发生中度及重度损伤风险为无跌倒/坠落史老年患者的1.224倍（95%CI=1.102～1.359），与李伟强等[17]研究中跌倒史是中国老年人跌倒及跌伤最重要影响因素的结果一致。姜宜君等[16]研究亦表明，与无跌倒史者相比，发生多次跌倒者通常会导致更严重的后果，如肢体功能损害、失能，甚至死亡。因此，对于有跌倒史的老年人，应采取更加积极的预防措施，如加强健康教育、改善环境因素、提供合适的辅助器具和进行针对性的康复训练等，以降低其再次跌倒并发生中度及重度损伤的风险。
综上所述，广州市跌倒/坠落老年患者中度及重度损伤发生率较高。因此，减少该地区老年人严重跌倒事件的发生显得尤为重要。建议相关部门在开展防控工作时对高危老年人采取分类分级干预措施，根据已识别的环境和行为方式危险因素开展相应的干预工作。在高发季节提前预警，从而减少严重跌倒事件的发生，提高老年人生命质量。由于监测数据仅来源于哨点医院门急诊，无法收集到事件发生过程的具体信息。因此，本研究纳入的危险因素较少；且受限于监测医院数量较少，研究数据对于全市代表性欠佳，因此结果外推到人群需谨慎。建议在今后的工作中进一步扩大数据收集范围，纳入更多类型医疗机构及社区层面数据，并开展专项调查，通过对严重跌倒事件过程的详细记录深入分析危险因素，为精准干预提供参考依据。

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2025年第41卷第12期
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doi: 10.11847/zgggws1146907
  • 接收时间：2025-01-09
  • 首发时间：2026-10-25
  • 出版时间：2025-12-10
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  • 收稿日期：2025-01-09
  • 修回日期：2025-04-28
  • 录用日期：2025-07-24
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    1广州市疾病预防控制中心，广州 510440
    2广州市荔湾区疾病预防控制中心，广州 510145

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species		 占总种数比例
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total species (%)		 属
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Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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