Background Falls in older age pose a major public health concern, with unclear urban–rural patterns of falls mortality in China. This study examines the trends of late-life falls mortality in urban and rural China over a 35-year period.

Methods Falls mortality data were sourced from China’s National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modelling to estimate age, period and cohort effects on fall-related mortality from 1987 to 2021. Net drift, local drift, longitudinal age curves and period relative risks were also calculated.

Results The age-standardised falls mortality in older age showed a long-term trend of initial decline prior to 2003, followed by a steep increase thereafter, with notable distinctions between urban and rural patterns. The rise in rural populations, particularly among older males, was more conspicuous. In rural areas, the decline in falls mortality diminished with age, contrary to the urban trend. Falls mortality increased with age in both urban and rural older populations, peaking in the group aged 85–89. The period effect curves of falls mortality in urban and rural areas both approximated a U-shaped pattern while there were minor variations in early cohorts.

Conclusions China has experienced a consistent rise in late-life falls mortality in recent years. Notably, there are significant urban–rural disparities in age, period and cohort effects of fall-related mortality among older adults. Rural residents, males and older age groups have potential higher fatal-falls risk. Targeted strategies should be implemented to prevent late-life falls.