Background Falls and fall-related injuries are a major public health issue among older adults worldwide. Causes and prognostic indicators of death in older patients with fall are lacking in Asian countries, especially in local older population. We aimed to assess the disease burden of fall and the usefulness of Charlson comorbidity index (CCI) and male sex as risk adjusted hospital mortality predictors in older Asian patients with fall using hospital administrative database. Methods: Historical cohort study of hospital discharge database from 1 January 2004 to 30 June 2015 to identify cases with fall and comorbidity using International Statistical Classification of Diseases and Related Health Problems, 9^th Revision, Australian Modification (ICD-9/10-AM) codes.

Results Over the study period, 16346 patients met the criteria of fall with hospital mortality rate of 4.3%. The hospital mortality rates (2.3%, 4.9%, 6.5%, and 10.9% respectively, P < 0.001) and hospital length of stay (geometric mean, 5.3, 6.1, 7.3, and 6.7 days, respectively, P < 0.001) increased consistently for patients with CCI ranging from none, low, moderate to high grade, respectively. Logistic regression model analysis showed that CCI (odds ratio, OR 5.7 high vs. none, p < 0.001) and male sex (OR 2.1, p < 0.001) were significant and independent predictors of hospital mortality. Similar results were also seen with hospital length of stay by zero-truncated negative binomial regression model analysis. Conclusion: The burden of fall is high in this older Asian population. Comorbidities and male sex were some of the most important contributors to hospital mortality and resource utilisation.