National and state-level burden of decubitus ulcers in the United States, 2010–2021

Summary: <br /> Decubitus ulcers, or pressure injuries (PI), are a major cause of morbidity, prolonged hospitalization, increased mortality, and increased healthcare costs, particularly among older adults and critically ill patients. This study evaluated the national and state-level incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of PIs in the United States from 2010 to 2021. This population-based study utilized established from the Global Burden of Disease 2021 framework to estimate age-standardized incidence rate (ASIR), prevalence (ASPR), mortality (ASMR), and DALY (ASDR) across all U.S. states. Bayesian meta-regression models accounted for underreporting; Monte Carlo simulations calculated 95%. Uncertainty intervals (UIs).<b> </b> In 2021, there were 706,150 incident cases of PI in the US (95% UI: 640,985–774,801), leading to 1,411 deaths (95% UI: 1,182–1,626) and 50,615 DALYs (95% UI: 41,961–59,890).<b> </b>ASIR was 119.18, ASPR was 31.83, ASMR was 0.22, and ASDR was 8.70 per 100,000. The burden was predominantly concentrated in older adults, with mortality, incidence, prevalence, and DALY rates peaking in individuals aged 95+ years, decreasing in younger groups, reinforcing aging as the strongest risk factor. State-level variations were noted, with the highest burden observed in the District of Columbia, Louisiana, and Mississippi, while the lowest rates were recorded in California, Vermont, and North Dakota. Temporal trend analysis suggested the COVID-19 pandemic was associated with an increase in ASIR and ASPR, likely due to prolonged hospitalization. Between 2010 and 2021, the prevalence and incidence rates increased in the US by 3.7% and 3.6%, respectively, while the mortality rate remained stable. The rising burden of PI underscores the need for better prevention and early detection, particularly in high-risk populations. Hossein Akbarialiabad¹, Robert S. Kirsner², Mark M. Melin³, Ayman Grada⁴ 1. University of Utah Health, Salt Lake City, UT, United States. 2. University of Miami Miller School of Medicine, Miami, FL, United States. 3. Mayo Clinic Minnesota, Rochester, MN, United States. 4. Case Western Reserve University, Cleveland, OH, United States. Clinical Research: Epidemiology and Observational Research