Socioeconomic Position and Falls Among Middle- and Older-Aged Adults: A Systematic Review with a Life Course Approach

BackgroundFalls among middle- and older-aged adults are a significant public health concern. However, a holistic understanding of how different indicators of socioeconomic position (SEP) are associated with falls is lacking, particularly for SEP across the life course. MethodsWe systematically searched for observational studies analysing the association between at least one indicator of SEP and one fall outcome. Due to heterogeneity between included studies, results were narratively synthesised. ResultsAfter de-duplication, 5,880 search results were screened and 125 studies were included. Only 14 included studies explicitly aimed to study the relationship between SEP and falls, which generally found that higher SEP was associated with lower risks/rates of falls. An additional nine studies also had relevant adjusted models that also largely showed a protective relationship. However, adjusted results were mixed and often lacked statistical significance. The remaining 102 studies only contained unadjusted results of interest, with 50%-100% of results for each SEP indicator showing that low SEP groups experience disproportionately high risks/rates of fall outcomes compared to high SEP groups. Notably, only four studies measured any SEP indicators from a stage of the life course prior to the study period. ConclusionsOur findings suggest that falls disproportionately impact low SEP groups and that knowledge gaps exist regarding the relationship between different SEP indicators and falls, particularly for SEP exposures across the life course. Future research on this topic should utilise causal diagrams for appropriate model building and include a wide range of SEP indicators across the life course.