Global Epidemiology, Burden, and Future Projections of Decubitus Ulcers: A Comprehensive Analysis From 1990 to 2050
Yungang Hu
Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorYaling Zhao
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorHuimin Wu
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorGuanqun Wan
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorXiaolin Li
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorCorresponding Author
Qi Zeng
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Correspondence:
Qi Zeng ([email protected])
Yuming Shen ([email protected])
Search for more papers by this authorCorresponding Author
Yuming Shen
Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
Correspondence:
Qi Zeng ([email protected])
Yuming Shen ([email protected])
Search for more papers by this authorYungang Hu
Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorYaling Zhao
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorHuimin Wu
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorGuanqun Wan
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorXiaolin Li
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Search for more papers by this authorCorresponding Author
Qi Zeng
Department of Plastic Surgery, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, China
Correspondence:
Qi Zeng ([email protected])
Yuming Shen ([email protected])
Search for more papers by this authorCorresponding Author
Yuming Shen
Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
Correspondence:
Qi Zeng ([email protected])
Yuming Shen ([email protected])
Search for more papers by this authorFunding: This study was supported by the Jiangxi Provincial Natural Science Foundation (20232BAB216055) and the Jiangxi Provincial Health Commission Science and Technology Plan Project (202310161).
ABSTRACT
Decubitus ulcers are common, hard-to-heal skin ulcers characterised by a high incidence, rapid progression, and a tendency to recur after healing. However, data on the burden and trends of this disease are limited. This study aimed to analyse the epidemiological characteristics and disease burden of decubitus ulcers from 1990 to 2021, and predict their future trends from 2022 to 2050. We retrieved decubitus ulcers data from 204 countries and regions worldwide from the Global Burden of Disease Study 2021 between 1990 and 2021. We analysed the prevalence, incidence, disability-adjusted life years (DALYs), age-standardised rates (ASRs), and estimated annual percentage changes at the global, regional, and national levels. Additionally, we examined global trends by age, sex, and socio-demographic index (SDI). Finally, we used the autoregressive integrated moving average and exponential smoothing models to predict future trends of the disease burden from 2022 to 2050. Globally, from 1990 to 2021, the incidence and prevalence of cases, deaths, and DALYs associated with decubitus ulcers revealed an increasing trend, while the corresponding ASRs exhibited a decreasing trend. Among all age groups, the elderly had the highest incidence, prevalence, and mortality rates. Regionally, high-income North America had the highest age-standardised incidence and prevalence rates; Southern Sub-Saharan Africa had the highest age-standardised death rate; and Eastern Sub-Saharan Africa had the highest age-standardised DALY rate. In terms of SDI, regions with a higher SDI had the highest age-standardised incidence and prevalence rates, while their mortality rates and DALYs were lower. By integrating the prediction results from the two models, we found that the incidence and prevalence of cases, deaths, and DALYs for both sexes will continue to increase from 2022 to 2050. However, the ASRs are expected to remain relatively stable in the future.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data used to support the findings of this study were extracted from the GBD 2021 database, which is freely available on http://ghdx.healthdata.org/gbd-results-tool.
Supporting Information
| Filename | Description |
|---|---|
| wrr70048-sup-0001-Figures.docxWord 2007 document , 2.1 MB |
Figure S1. Numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs for both sexes in 2021. DALYs, disability-adjusted life years. Figure S2. Numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs for different age groups in 2021. DALYs, disability-adjusted life years. Figure S3. Numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs for different SDI regions in 2021. DALYs, disability-adjusted life years. Figure S4. Numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs for different GBD regions in 2021. DALYs, disability-adjusted life years. Figure S5. Trends in the numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs globally by sexes from 1990 to 2021. DALYs, disability-adjusted-life-years. Figure S6. Trends in the numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs globally by age groups from 1990 to 2021. DALYs, disability-adjusted-life-years. Figure S7. Trends in the numbers and age-standardised rates of decubitus ulcer-related incidence, prevalence, deaths, and DALYs globally by SDI regions from 1990 to 2021. DALYs, disability-adjusted-life-years. |
| wrr70048-sup-0002-Tables.docxWord 2007 document , 259.3 KB |
Table S1. The number of incidence cases and the age-standardised incidence rate of decubitus ulcer in 1990 and 2021, and its trends from 1990 to 2021 globally. Table S2. The number of prevalence cases and the age-standardised prevalence rate of decubitus ulcer in 1990 and 2021, and its trends from 1990 to 2021 globally. Table S3. The number of deaths cases and the age-standardised deaths rate of decubitus ulcer in 1990 and 2021, and its trends from 1990 to 2021 globally. Table S4. The number of DALYs cases and the age-standardised DALYs rate of decubitus ulcer in 1990 and 2021, and its trends from 1990 to 2021 globally. Abbreviations: DALYs, disability-adjusted-life-years. Table S5. The predicted results in the decubitus ulcer-related numbers and age-standardised rates of incidence, prevalence, deaths, DALYs by sex globally from 2022 to 2050 of the ARIMA model. ARIMA, autoregressive integrated moving average; DALYs, disability-adjusted-life-years. Table S6. The predicted results in the decubitus ulcer-related numbers and age-standardised rates of incidence, prevalence, deaths, DALYs by sex globally from 2022 to 2050 of the ES model. DALYs, disability-adjusted-life-years; ES, exponential smoothing. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1B. Hajhosseini, M. T. Longaker, and G. C. Gurtner, “Pressure Injury,” Annals of Surgery 271, no. 4 (2020): 671–679.
- 2C. Shi, J. C. Dumville, N. Cullum, S. Rhodes, A. Jammali-Blasi, and E. McInnes, “Alternating Pressure (Active) air Surfaces for Preventing Pressure Ulcers,” Cochrane Database of Systematic Reviews 5, no. 5 (2021): CD013620.
- 3A. J. Visconti, O. I. Sola, and P. V. Raghavan, “Pressure Injuries: Prevention, Evaluation, and Management,” American Family Physician 108, no. 2 (2023): 166–174.
- 4Y. Lyu, Y. L. Huang, Z. Y. Li, and F. Lin, “Interventions and Strategies to Prevent Medical Device-Related Pressure Injury in Adult Patients: A Systematic Review,” Journal of Clinical Nursing 32, no. 19 (2023): 6863–6878.
- 5M. Artico, A. Dante, D. D'Angelo, et al., “Prevalence, Incidence and Associated Factors of Pressure Ulcers in Home Palliative Care Patients: A Retrospective Chart Review,” Palliative Medicine 32, no. 1 (2018): 299–307, https://doi.org/10.1177/0269216317737671.
- 6A. Ferris, A. Price, and K. Harding, “Pressure Ulcers in Patients Receiving Palliative Care: A Systematic Review,” Palliative Medicine 33, no. 7 (2019): 770–782.
- 7K. E. Rudd, S. C. Johnson, K. M. Agesa, et al., “Global, Regional, and National Sepsis Incidence and Mortality, 1990-2017: Analysis for the Global Burden of Disease Study,” Lancet 395, no. 10219 (2020): 200–211.
- 8C. Murray, “The Global Burden of Disease Study at 30 Years,” Nature Medicine 28, no. 10 (2022): 2019–2026.
- 9A. Yakupu, H. Wang, L. Huang, et al., “Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer From 1990 to 2019: A Systematic Analysis for the Global Burden of Disease 2019,” International Journal of Lower Extremity Wounds Early View, https://doi.org/10.1177/15347346221092265.
- 10X. Zhang, N. Zhu, Z. Li, X. Xie, T. Liu, and G. Ouyang, “The Global Burden of Decubitus Ulcers From 1990 to 2019,” Scientific Reports 11, no. 1 (2021): 21750.
- 11 GBD 2021 Diabetes Collaborators, “Global, Regional, and National Burden of Diabetes From 1990 to 2021, With Projections of Prevalence to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021,” Lancet 402, no. 10397 (2023): 203–234, https://doi.org/10.1016/S0140-6736(23)01301-6.
- 12 GBD 2019 Diabetes and Air Pollution Collaborators, “Estimates, Trends, and Drivers of the Global Burden of Type 2 Diabetes Attributable to PM(2·5) air Pollution, 1990-2019: An Analysis of Data From the Global Burden of Disease Study 2019,” Lancet Planetary Health 6, no. 7 (2022): e586–586e600.
- 13 GBD 2021 Fertility and Forecasting Collaborators, “Global Fertility in 204 Countries and Territories, 1950-2021, With Forecasts to 2100: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2021,” Lancet 403, no. 10440 (2024): 2057–2099, https://doi.org/10.1016/S0140-6736(24)00550-6.
10.1016/S0140-6736(24)00550-6 Google Scholar
- 14R. Sugathapala, S. Latimer, A. Balasuriya, W. Chaboyer, L. Thalib, and B. M. Gillespie, “Prevalence and Incidence of Pressure Injuries Among Older People Living in Nursing Homes: A Systematic Review and Meta-Analysis,” International Journal of Nursing Studies 148 (2023): 104605.
- 15Z. Li, F. Lin, L. Thalib, and W. Chaboyer, “Global Prevalence and Incidence of Pressure Injuries in Hospitalised Adult Patients: A Systematic Review and Meta-Analysis,” International Journal of Nursing Studies 105 (2020): 103546.
- 16S. O. Labeau, E. Afonso, J. Benbenishty, et al., “Prevalence, Associated Factors and Outcomes of Pressure Injuries in Adult Intensive Care Unit Patients: The DecubICUs Study,” Intensive Care Medicine 47, no. 2 (2021): 160–169.
- 17M. H. Ahtiala, R. Kivimäki, R. Laitio, and E. T. Soppi, “The Association Between Pressure Ulcer/Injury Development and Short-Term Mortality in Critically Ill Patients: A Retrospective Cohort Study,” Wound Management and Prevention 66, no. 2 (2020): 14–21.
- 18A. Lichterfeld-Kottner, N. Lahmann, and J. Kottner, “Sex-Specific Differences in Prevention and Treatment of Institutional-Acquired Pressure Ulcers in Hospitals and Nursing Homes,” Journal of Tissue Viability 29, no. 3 (2020): 204–210.
- 19M. D. Banks, J. Webster, J. Bauer, et al., “Effect of Supplements/Intensive Nutrition on Pressure Ulcer Healing: A Multicentre, Randomised Controlled Study,” Journal of Wound Care 32, no. 5 (2023): 292–300.
- 20R. Jansen, K. Silva, and M. Moura, “Braden Scale in pressure ulcer risk assessment,” Revista Brasileira de Enfermagem 73, no. 6 (2020): e20190413.
- 21L. Marchon and H. Maillard, “Epidemiology of Pressure Ulcers in Le Mans General Hospital Between 1996 and 2019: Impact of a Dedicated Pressure Ulcer, Wounds and Healing Task Force,” International Wound Journal 20, no. 10 (2023): 4097–4102.
- 22L. L. Saunders and J. S. Krause, “Personality and Behavioral Predictors of Pressure Ulcer History,” Topics in Spinal Cord Injury Rehabilitation 16, no. 2 (2010): 61–71.
- 23J. Ospel, N. Singh, A. Ganesh, and M. Goyal, “Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care,” Journal of Stroke 25, no. 1 (2023): 16–25.
- 24L. J. Shaw, C. J. Pepine, J. Xie, et al., “Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine,” Journal of the American College of Cardiology 70, no. 3 (2017): 373–388, https://doi.org/10.1016/j.jacc.2017.05.051.
- 25H. Merdji, M. T. Long, M. Ostermann, et al., “Sex and Gender Differences in Intensive Care Medicine,” Intensive Care Medicine 49, no. 10 (2023): 1155–1167.
- 26Q. Liu, W. Yan, C. Qin, et al., “Incidence and Mortality Trends of Neglected Tropical Diseases and Malaria in China and ASEAN Countries From 1990 to 2019 and Its Association With the Socio-Demographic Index,” Global Health Research and Policy 8, no. 1 (2023): 22.
- 27J. Bai, J. Cui, F. Shi, and C. Yu, “Global Epidemiological Patterns in the Burden of Main Non-Communicable Diseases, 1990–2019: Relationships With Socio-Demographic Index,” International Journal of Public Health 68 (2023): 1605502.
- 28F. Rezaei, A. Mazidimoradi, Z. Pasokh, et al., “Global Trend of Cervical Cancer Among Women Aged 55 and Older From 2010 to 2019: An Analysis by Socio-Demographic Index and Geographic Regions,” Aging Medicine 7, no. 5 (2024): 614–635.
- 29Y. Wang, J. Liang, Y. Fang, et al., “Burden of Common Neurologic Diseases in Asian Countries, 1990-2019: An Analysis for the Global Burden of Disease Study 2019,” Neurology 100, no. 21 (2023): e2141–e2154.
- 30L. Xiang, S. Kua, and A. Low, “Work Productivity and Economic Burden of Systemic Sclerosis in a Multiethnic Asian Population,” Arthritis Care & Research (Hoboken) 74, no. 5 (2022): 818–827.
- 31L. Jensen, S. M. Monnat, J. J. Green, L. M. Hunter, and M. J. Sliwinski, “Rural Population Health and Aging: Toward a Multilevel and Multidimensional Research Agenda for the 2020s,” American Journal of Public Health 110, no. 9 (2020): 1328–1331.
- 32L. Huang, Y. Yan, Y. Huang, et al., “Summary of Best Evidence for Prevention and Control of Pressure Ulcer on Support Surfaces,” International Wound Journal 20, no. 6 (2023): 2276–2285.
- 33J. S. Mervis and T. J. Phillips, “Pressure Ulcers: Prevention and Management,” Journal of the American Academy of Dermatology 81, no. 4 (2019): 893–902.
- 34M. Wang, J. Pan, X. Li, et al., “ARIMA and ARIMA-ERNN Models for Prediction of Pertussis Incidence in Mainland China From 2004 to 2021,” BMC Public Health 22, no. 1 (2022): 1447.
- 35W. Yang, A. Su, and L. Ding, “Application of Exponential Smoothing Method and SARIMA Model in Predicting the Number of Admissions in a Third-Class Hospital in Zhejiang Province,” BMC Public Health 23, no. 1 (2023): 2309.
- 36J. Kottner, J. Cuddigan, K. Carville, et al., “Pressure Ulcer/Injury Classification Today: An International Perspective,” Journal of Tissue Viability 29, no. 3 (2020): 197–203.
- 37P. Ghorbani Vajargah, A. Mollaei, A. Falakdami, et al., “A Systematic Review of Nurses' Practice and Related Factors Toward Pressure Ulcer Prevention,” International Wound Journal 20, no. 6 (2023): 2386–2401.
- 38C. S. Wan, H. Cheng, M. Musgrave-Takeda, et al., “Barriers and Facilitators to Implementing Pressure Injury Prevention and Management Guidelines in Acute Care: A Mixed-Methods Systematic Review,” International Journal of Nursing Studies 145 (2023): 104557.
- 39B. M. Gillespie, R. M. Walker, S. L. Latimer, et al., “Repositioning for Pressure Injury Prevention in Adults: An Abridged Cochrane Systematic Review and Meta-Analysis,” International Journal of Nursing Studies 120 (2021): 103976.
- 40C. Shi, J. C. Dumville, N. Cullum, et al., “Beds, Overlays and Mattresses for Preventing and Treating Pressure Ulcers: An Overview of Cochrane Reviews and Network Meta-Analysis,” Cochrane Database of Systematic Reviews 8, no. 8 (2021): CD013761.
- 41S. Mäki-Turja-Rostedt, H. Leino-Kilpi, M. Koivunen, T. Vahlberg, and E. Haavisto, “Consistent Pressure Ulcer Prevention Practice: The Effect on PU Prevalence and PU Stages, and Impact on PU Prevention-A Quasi-Experimental Intervention Study,” International Wound Journal 20, no. 6 (2023): 2037–2052.
- 42S. Everett Day, B. Koirala, and K. McIltrot, “Repositioning Strategies to Prevent Pressure Injuries in the ICU: Integrative Review on Implementation Factors,” Advances in Skin & Wound Care 35, no. 6 (2022): 344–351.
- 43O. A. Arowojolu and G. A. Wirth, “Sacral and Ischial Pressure Ulcer Management With Negative-Pressure Wound Therapy With Instillation and Dwell,” Plastic and Reconstructive Surgery 147, no. 1 (2021): 61S–67S.
- 44J. Shi, Y. Gao, J. Tian, et al., “Negative Pressure Wound Therapy for Treating Pressure Ulcers,” Cochrane Database of Systematic Reviews 5, no. 5 (2023): CD011334.
