Global Burden of Decubitus Ulcer and Its Association with Socioeconomics from 1990 to 2019

Abstract

Background: Decubitus ulcers (DUs) have no cure and are of significant health and economic concern worldwide. Data about the global and regional variations in the levels and trends of decubitus ulcer are required to learn the burden of this disease and help decision makers effectively allocate resources. Here we aimed to summarize the incidence, mortality and disability-adjusted life-year (DALY) caused by decubitus ulcer and evaluate its association with socioeconomics in 204 countries and territories between 1990 and 2019. Methods: The incidence, mortality, and disability-adjusted life-year (DALY) rates attributed to decubitus ulcer were obtained from GBD 2019, which were stratified by country and territory, sex, and level of Socio-demographic Index (SDI). The association between burden of decubitus ulcers and socioeconomic development status, represented in SDI, was also described. All of the estimates are reported as counts and age-standardized rates per 100 000 person-years. Results: In 2019, the age-standardized incidence rate of DU was 41·8 (95% CI 37·8-46·2) per 100,000 persons, which decreased from 46·5 to 41·8 per 100,000 persons from 1990 to 2019. DU was also responsible for 481422·8 (374,333·9-583,429·1) DALYs globally in 2019, with its deaths accounted for 24,388·6 (17,299·1-31,260·8) at the global level. Between 1990 and 2019, the age-standardized DALYs rate decreased from 7·8 to 6·2 per 100,000 persons and the age-standardized death rate decreased from 0·4 to 0·3 per 100,000 persons. From 1990 to 2019, males exhibited higher incidence and DALYs rates for DU than females, whereas females have higher death rate than males in the same period. The incidence, death and DALYs rates of DU increased non-linearly with age. Stratified using SDI, high, high-middle and middle SDI locations recorded the highest age-standardized incidence and DALYs rates compared to that were lower in low-middle and low SDI locations. The age-standardized DALYs rate in the high SDI locations showed particularly decreasing trend (−40·2% [-47·4 to -29·9]) compared to that in low, low-middle, middle, and high-middle SDI locations. Interpretation: There is a pronounced association between socioeconomic development status and global burden of decubitus ulcer. Higher burden of DU-related incidence rate noted for rich countries, and the highest decreasing trend of DALYs rate was also identified in high SDI countries. Data of GBD 2019 are valuable for the development and evaluation of DU-specific prevention measures and resource allocation, particularly in countries with high incidence or increasing burden. Funding: This work was supported by grants from Starting Package of Xiang'an Hospital of Xiamen University (PM201809170010). Declaration of Interest: We declare no competing interests.