Deaths from falls and fractures. Comparison of mortality in Scotland and the United States with that in England and Wales

Abstract

In England and Wales there is a close relationship between total deaths attributed to falls and deaths attributed to fractures of limbs in men and women aged 75 years and over, similar to the relationship between deaths from domestic falls and fractures over the age of 55 years. This relationship enables comparisons to be made between published statistics of mortality from falls as indicators of comparative mortality from fractures in populations of elderly people in Britain (including Scotland) and the United States of America. Since 1931, annual Scottish mortalities have been higher but showed a similar trend to those in England and Wales with a recession during the wartime decade 1940 to 1950 followed by a rise in 1950 to 1960. Throughout this century mortality from falls of elderly 'non whites' in the USA has been much lower than Caucasian mortality in Britain, and the USA American 'whites' had a very high mortality early in this century rising to a peak in 1938, falling since then to reach the same level as in England and Wales by 1958. Possible causes for these differences between populations are: observed differences in secular trends in adult stature and hence in skeletal mass; the greater skeletal mass and lower susceptibility to osteoporosis and fracture of American Negroes; the effects of immigration on mean stature of the population of American 'whites'; the effect of increased dietary vitamin D through fortification of American milk since 1930; the exposure of elderly people to sunlight and its relationship to latitude in Britain.