The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries

Lee Smith; Guillermo F López Sánchez; Jae Il Shin; Hans Oh; Karel Kostev; Mark A Tully; Yvonne Barnett; Laurie T Butler; Nicola Veronese; Pinar Soysal; Louis Jacob; Ai Koyanagi

doi:10.1007/s10433-025-00848-y

The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries

Lee Smith, Guillermo F López Sánchez, Jae Il Shin, Hans Oh, Karel Kostev, Mark A Tully, Yvonne Barnett, Laurie T Butler, Nicola Veronese, Pinar Soysal, Louis Jacob, Ai Koyanagi

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Abstract

Studies from high-income countries have shown that multimorbidity is associated with increased fall risk among older adults. However, studies specifically on this topic from low- and middle-income counties (LMICs) are lacking. Thus, we aimed to assess this association among adults aged ≥ 50 years from six LMICs.

Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Eleven chronic physical conditions were assessed. The presence of past 12-month fall-related injury was ascertained through self-reported information. Multivariable logistic regression and mediation analysis was conducted to assess the association between multimorbidity and fall-related injury.

Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; males 48.0%] were analyzed. Overall, compared to having no chronic conditions, having 2, 3, and ≥ 4 chronic conditions were significantly associated with 1.67 (95%CI = 1.21–2.30), 2.64 (95%CI = 1.89–3.68), and 3.67 (95%CI = 2.42–5.57) times higher odds for fall-related injury. The association between multimorbidity (i.e., ≥ 2 chronic conditions) and fall-related injury was mainly explained by pain/discomfort (mediated% 39.7%), mobility (34.1%), sleep/energy (24.2%), and cognition (13.0%).

Older adults with multimorbidity in LMICs are at increased odds for fall-related injury. Targeting the identified potential mediators among those with multimorbidity may reduce fall risk in this population.

Original language	English
Article number	12
Pages (from-to)	1-10
Number of pages	10
Journal	European journal of ageing
Volume	22
Issue number	1
Early online date	20 Mar 2025
DOIs	https://doi.org/10.1007/s10433-025-00848-y
Publication status	Published (in print/issue) - 20 Mar 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

Data Access Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Dr. Guillermo F. López Sánchez is funded by the European Union – Next Generation EU.

Funders	Funder number
European Commission
National Institute on Aging	R01-AG034479, YA1323–08-CN-0020, OGHA 04034785, Y1-AG-1005–01, R21-AG034263
National Institute on Aging

Keywords

Low-and middle-income countries
falls
Multimorbidity
Chronic disease
Epidemiology
Falls
epidemiology
Low-and Middle-income Countries

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s10433-025-00848-y

s10433-025-00848-y (1)Final published version, 490 KBLicence: CC BY

Cite this

Smith, L., López Sánchez, G. F., Shin, J. I., Oh, H., Kostev, K., Tully, M. A., Barnett, Y., Butler, L. T., Veronese, N., Soysal, P., Jacob, L., & Koyanagi, A. (2025). The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries. European journal of ageing, 22(1), 1-10. Article 12. https://doi.org/10.1007/s10433-025-00848-y

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abstract = "Studies from high-income countries have shown that multimorbidity is associated with increased fall risk among older adults. However, studies specifically on this topic from low- and middle-income counties (LMICs) are lacking. Thus, we aimed to assess this association among adults aged ≥ 50 years from six LMICs. Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Eleven chronic physical conditions were assessed. The presence of past 12-month fall-related injury was ascertained through self-reported information. Multivariable logistic regression and mediation analysis was conducted to assess the association between multimorbidity and fall-related injury. Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; males 48.0\%] were analyzed. Overall, compared to having no chronic conditions, having 2, 3, and ≥ 4 chronic conditions were significantly associated with 1.67 (95\%CI = 1.21–2.30), 2.64 (95\%CI = 1.89–3.68), and 3.67 (95\%CI = 2.42–5.57) times higher odds for fall-related injury. The association between multimorbidity (i.e., ≥ 2 chronic conditions) and fall-related injury was mainly explained by pain/discomfort (mediated\% 39.7\%), mobility (34.1\%), sleep/energy (24.2\%), and cognition (13.0\%). Older adults with multimorbidity in LMICs are at increased odds for fall-related injury. Targeting the identified potential mediators among those with multimorbidity may reduce fall risk in this population.",

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Smith, L, López Sánchez, GF, Shin, JI, Oh, H, Kostev, K, Tully, MA, Barnett, Y, Butler, LT, Veronese, N, Soysal, P, Jacob, L & Koyanagi, A 2025, 'The association between physical multimorbidity and fall-related injury among adults aged ≥ 50 years from low- and middle-income countries', European journal of ageing, vol. 22, no. 1, 12, pp. 1-10. https://doi.org/10.1007/s10433-025-00848-y

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