Cardiac-MSK Patients at Highest Risk for Falls and Death Save

A new study by researchers at Peking University and the Chinese PLA General Hospital has found that multimorbidity—living with multiple chronic diseases—is closely associated with worsening fall conditions and mortality among middle-aged and older adults in China. The findings, published in Health Data Science, identify a distinct group at especially high risk: individuals with both cardiovascular and musculoskeletal conditions, dubbed the “osteo-cardiovascular fallers.”

Falls are a major cause of injury and death in older populations globally, particularly in low- and middle-income countries like China. While previous research linked chronic illnesses with increased fall risk, this study is one of the first to show how different patterns of multimorbidity affect transitions between fall states—ranging from no falls to mild, severe falls, and even death—over time.

Analyzing data from 14,244 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS), the researchers used advanced statistical models to trace how health conditions influenced nearly 11,000 transitions between fall states over a seven-year period. They identified four main multimorbidity patterns: osteo-cardiovascular, pulmonary-digestive-rheumatic, metabolic-cardiovascular, and neuropsychiatric-sensory. Among them, the osteo-cardiovascular group had the highest risk of transitioning from no falls to severe falls or death, and the lowest likelihood of recovering from a previous fall.

“Multimorbidity, especially the osteo-cardiovascular pattern, significantly worsens the likelihood of a fall or death and reduces the chance of improvement,” said lead author Mingzhi Yu, a doctoral student at the School of Public Health, Peking University. “These findings provide clear guidance for targeted clinical interventions and preventive strategies.”

The study further showed that individuals with this pattern faced a 2.09 times higher risk of death and a 1.67 times higher risk of severe falls compared to healthy participants. Moreover, their chances of recovery—such as improving from severe to mild falls—were significantly lower than others.

“Our work highlights the need for integrated care approaches tailored to patients with overlapping bone and heart diseases,” said co-author Dr. Lihai Zhang, Chief Physician at the Chinese PLA General Hospital. “Addressing both systems simultaneously may prevent long-term deterioration.”

The research team plans to build on these insights by identifying additional fall-related risk factors and developing practical fall prevention strategies for high-risk groups.