Increasing pressure ulcer burden in China: Age and gender differences based on GBD data

To analyze the burden of pressure ulcers and its changing trends among the general population (all age groups) and the elderly aged 65 years and above in China based on the global burden of disease (GBD) data from 1990 to 2021, predict the burden trends from 2022 to 2035, and address the public health issues of its unclear medium- and long-term trends and insufficient precise interventions in its prevention and control in order to provide support for formulating targeted prevention and control strategies.

The GBD database was used to extract the incidence, mortality and disability-adjusted life years (DALYs) of pressure ulcers in the general population and in the elderly aged 65 years and above in China from 1990 to 2021. Meanwhile, the age-standardized incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life rate (ASDR) of the general population were also extracted, and the age-standardized rate (ASRs) corresponding to the elderly population aged 65 years and above were estimated based on the GBD 2021 standard population. The average annual percentage changes (EAPCs) of ASRs were calculated to assess the trends. Bayesian age-period-cohort (BAPC) model was adopted to predict the ASRs and their changing trends of the general and elderly population from 2022 to 2035, respectively.

From 1990 to 2021, the number of pressure ulcer cases in the general population of China increased from 163508.67 (95%CI: 142891.48~184055.10) cases to 397312.27 (95%CI: 360058.44~444875.78) cases, the number of deaths soared from 242.51 (95%CI: 125.26~702.84) cases to 3131.54 (95%CI: 1562.60~4126.85) cases, and DALYs increased from 11965.10 (95%CI: 7820.54~21703.78) to 61933.91 (95%CI: 36313.26~77402.42). During the same period, the EAPCs of ASIR, ASMR and ASDR were 1.06 (95%CI: 0.84~1.28), 3.63 (95%CI: 3.45~3.81), and 2.76 (95%CI: 2.60~2.92), respectively. In 2021, the number of male cases and DALYs were both higher than those of females, while the number of deaths was similar. The ASIR, ASMR and ASDR of the males were all higher than those of the females, and the growth rates of both genders were relatively fast. All indicators were increased significantly with age. It is predicted that by 2035, the ASIR, ASMR, and ASDR in the general Chinese population will continue to rise significantly. From 1990 to 2021, the number of pressure ulcer cases among the elderly (≥65 years old) in China increased from 42334.95 (95%CI: 35739.05~48930.84) to 238431.65 (95%CI: 212539.53~264323.77). The number of deaths rose from 204.97 (95%CI: 93.33~316.60) to 2871.02 (95%CI: 2334.39~3407.66), and DALYs increased from 4619.74 (95%CI: 2990.73~6248.76) to 43968.28 (95%CI: 37542.85~50393.70). The EAPCs of ASIR, ASMR, and ASDR were 2.62 (95%CI: 2.44~2.80), 3.54 (95%CI: 3.38~3.70), and 3.28 (95%CI: 3.14~3.42), all of which increased significantly. In 2021, the number of cases, deaths and DALYs among elderly men and women were similar, but the ASIR, ASMR and ASDR of men were all higher than those of women, and their growth rates were faster. It is projected that by 2035, the ASIR of the elderly population will significantly decline to 146.24(95%CI: 140.35~152.14), with an EAPC of -0.57 (95%CI: -0.64~-0.50), while the ASMR and ASDR will continue to rise and remain higher in males than in females.

From 1990 to 2021, the number of pressure ulcer cases, deaths and DALYs among the general population and the elderly in China increased significantly, and the ASRs rose rapidly. The burden of pressure ulcers increases significantly with age and is higher in men than in women. Predictions show that ASIR in the general population will continue to rise, while that in the elderly will slightly decline. However, the ASMR and ASDR will continue to increase.

Continuously strengthen the prevention and control of pressure ulcers, implement precise intervention for the elderly, especially older men, promote standardized nursing guidelines, enhance training and resource input in primary medical care, and establish a national pressure ulcer monitoring system.