Burden of Pressure Injuries

Findings From the Global Burden of Disease Study

Charalampos Siotos, MD; Andrew M Bonett, MD; George Damoulakis; Adan Z Becerra, PhD; George Kokosis, MD; Keith Hood, MD; Amir H Dorafshar, MD; Deana S Shenaq, MD


ePlasty. 2022;22(e19) 

In This Article

Abstract and Introduction


Background: Pressure injuries remain among the most common problems faced by plastic surgeons and comprise a large portion of wound clinic practice. However, little is known about the overall morbidity related to the disease. This research sought to identify the burden related to the diagnosis of pressure injuries.

Methods: We used the Global Burden of Disease Study 2017 to extract information about incidence and disability-adjusted life years (DALYs) related to pressure injuries from 1990 to 2017. Descriptive statistics were used to identify changes in the outcomes of interest.

Results: A relative though not statistically significantly decrease in the incidence and burden of pressure injuries was observed between 1990 and 2017. Rates of incidence in the US appear higher than other higher socio-demographic index countries. No clinically and statistically significant changes were observed based on age or sex.

Conclusions: Pressure injury incidence and burden have remained relatively stable between 1990 and 2017 with no significant improvement noted. There is room for improvement on a national performance level, and further research is needed regarding inconsistencies in regional outcomes.


Pressure injuries, also known as decubitus ulcers or pressure ulcers, continue to plague patients and the healthcare community.[1] Despite advances in medicine, the incidence of pressure injuries has remained stable and even slightly increased over more recent years according to some existing literature.[2,3] Multiple studies have attempted to quantify the problem. A meta-analysis by Li et al suggested the global prevalence of pressure ulcer to be 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4%.[2] A systematic review by Tubaishat et al estimated a global prevalence in the acute care setting to be between 6 and 18.5%.[3]

Many believe pressure injury to be a widely preventable disease with much more room for improvement. In fact, there was unanimous consensus by the National Pressure Ulcer Advisory Panel (NPUAP) in 2010 that although not all pressure injuries are avoidable, most are.[4] The basis for this idea stems from the understanding that the majority of pressure injuries in both the ambulatory and hospital settings, including hospital-acquired pressure injuries, are stage I or stage II. In their global review, Li et al showed that stage I and II ulcers comprised 71.5% of all ulcers.[2]

Whereas there is a well-known financial burden, relatively little is known about the overall morbidity related to the disease. Additionally, attempting to quantify morbidity objectively can become rather complex. One practical indicator that is often used is the disability-adjusted life year (DALY), which considers both mortality and morbidity. It is the sum of years of life lost (YLL) due to a disease and years living with the disease (YLD). The YLL is determined using a standardized life expectancy table based on age at time of death. The YLD is more complex and is a calculation based on the prevalence of the disease and its weighted level of severity.[5,6] Implementation of the DALY as a quantifiable variable has been integral for studies such as the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017).

By extracting data from GBD 2017, this research sought to identify the incidence as well as the burden related to the diagnosis of pressure injury of any stage in the US.