Association Between Upper Limb Injury and Risk of Falls: A Nationwide Population-Based Cohort Study

Background/Objectives: Falls and upper limb injuries (ULI) are prevalent in older adults, yet whether ULI independently predisposes to subsequent falls remains poorly characterized. This nationwide cohort study evaluated the association between ULI and future fall risk using Taiwan's National Health Insurance Research Database (2011-2019, follow-up through 2020). Methods: Adults aged ≥ 50 years with newly diagnosed ULI-defined as fractures (clavicle, scapula, humerus, radius, ulna, hand), sprains, strains, or open wounds of the shoulder, arm, elbow, forearm, wrist, or hand-were propensity score-matched 1:1 to controls by age, sex, and eight major comorbidities. Fall occurrence was identified by validated ICD codes, and Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: The cohort included 110,600 participants (mean follow-up 4.4 years). Fall incidence was 2.8 versus 1.6 per 1000 person-years in ULI versus control groups. Patients with ULI had 62% higher fall risk (adjusted HR 1.62, 95% CI: 1.43-1.84, p < 0.001), corresponding to 1.2 additional falls per 1000 person-years. Kaplan-Meier curves showed early divergence sustained throughout follow-up. Conclusions: ULI is independently associated with subsequent fall risk in older adults and may serve as a sentinel marker warranting fall-prevention strategies in clinical practice.