Background Falls are a significant public health concern, particularly among older adults. This study aimed to analyse trends in fall-related mortality in Spain from 1999 to 2022, focusing on age and gender disparities.

Methods Using a longitudinal ecological study, we analysed trends in fall mortality. Using data from the Spanish National Institute of Statistics, age-standardised mortality rates (ASMRs) were calculated for different age groups and genders. Joinpoint regression analysis was employed to identify significant trends and calculate annual percentage changes in mortality rates.

Results Fall deaths in Spain surged from 1999 to 2022, with a significant increase in mortality rates. This increase was more pronounced among men than women, and the older adults aged 65 and older accounted for most fall-related deaths. Overall, ASMRs increased with age and were consistently higher for men across all age groups. Men experienced a 1.9% annual increase in ASMRs, with a significant rise starting in 2009. Women’s ASMRs increased by 1.8% per year, with a more pronounced increase from 2007 to 2013 before slowing. Among those aged 65 and over, rates increased significantly across most age groups, with the ASMR for men rising by 2.7% per year and for women by 2%.

Conclusions Fall mortality in Spain has significantly increased, particularly among older adults and men. The findings underscore the need for targeted fall prevention strategies, especially for high-risk groups. Future interventions should address gender-specific risks and emerging issues in middle-aged adults to effectively reduce fall-related mortality across all age groups.