Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study

Shaojie Li; Guanghui Cui; Yuliang Er; Pengpeng Ye; Tao Xue; Junfeng Jim Zhang; Xiaoyun Liu; Leilei Duan; Faqin Lv; Yao Yao

doi:10.1093/geroni/igad121

Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study

Innov Aging. 2023 Oct 20;7(9):igad121. doi: 10.1093/geroni/igad121. eCollection 2023.

Authors

Shaojie Li^{1

2}, Guanghui Cui³, Yuliang Er⁴, Pengpeng Ye⁴, Tao Xue^{1

5}, Junfeng Jim Zhang⁶, Xiaoyun Liu², Leilei Duan⁴, Faqin Lv⁷, Yao Yao^{2

8}

Affiliations

¹ School of Public Health, Peking University, Beijing, China.
² China Center for Health Development Studies, Peking University, Beijing, China.
³ Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Beijing, China.
⁴ Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁶ Global Health Institute and the Nicholas School of Environment, Duke University, Durham, North Carolina, USA.
⁷ Ultrasonic Department, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
⁸ Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.

Abstract

Background and objectives: Housing is one of the main places where falls occur; however, few studies have examined housing environmental factors driving fall risk. This study aimed to explore the associations between housing environmental factors and falls in China.

Research design and methods: The study included data of middle-aged and older adults aged ≥45 years from 4 waves of the China Health and Retirement Longitudinal Study. We assessed 7 housing environmental factors: building materials, toilet types, household tidiness, household cooking fuels, and access to electricity, running water, and bathing facilities. Based on these, we divided housing environments into 3 types: good (0-2 poor factors), moderate (3-5 poor factors), and poor (6-7 poor factors). Falls incidence (yes or no) was self-reported during the survey period. We applied the Cox proportional hazard model to estimate the associations, adjusting for a set of covariates such as sociodemographic characteristics, lifestyles, and disease status.

Results: A total of 12,382 participants were analyzed, and the incidence of falls was 31.7%. According to the fully adjusted model, having a squatting toilet (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.03-1.26), household untidiness (HR = 1.09, 95% CI = 1.01-1.18), and solid fuel use for cooking (HR = 1.10, 95% CI = 1.02-1.18) were associated with a higher risk of falls (ps < .05), compared to their counterparts. We found a linear relationship between housing environments and falls (p for trend = .001). Specifically, moderate (HR = 1.16, 95% CI = 1.06-1.27) and poor housing environments (HR = 1.21, 95% CI = 1.08-1.34) were associated with a higher risk of falls compared to a good housing environment.

Discussion and implications: Among middle-aged and older Chinese adults, a better household environment, including sitting toilets, tidy living conditions, and clean fuel use for cooking, may reduce the risk of falls. The evidence from our study suggests the need to implement age-friendly housing environments to prevent falls and disability in an aging society.

Keywords: Cohort study; Falls; Housing environments; Middle-aged and older adults.

Published by Oxford University Press on behalf of The Gerontological Society of America 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.