Pressure ulcers: more lethal than we thought?

Abstract

Objective: To investigate the burden of pressure ulcer-associated mortality in the United States and to examine racial/ethnic differences and associated comorbidities.

Design: A descriptive study with matched odds ratio comparisons.

Setting: The United States, 1990-2001.

Participants: Pressure ulcer-associated deaths were identified from national multiple cause-coded death records from 1990 to 2001.

Main outcome measures: Age-adjusted mortality rates and matched odds ratio comparisons of pressure ulcer-associated deaths with deaths from other conditions.

Main results: Between 1990 and 2001, pressure ulcers were reported as a cause of death among 114,380 persons (age-adjusted mortality rate, 3.79 per 100,000 population; 95% confidence interval [CI], 3.77-3.81). For 21,365 (18.7%) of these deaths, pressure ulcers were reported as the underlying cause. Nearly 80% of pressure ulcer-associated deaths occurred in persons at least 75 years old. Septicemia was reported in 39.7% of pressure ulcer-associated deaths (matched odds ratio, 11.3; 95% CI, 11.0-11.7). Multiple sclerosis, paralysis, Alzheimer disease, osteoporosis, and Parkinson disease were reported more often in pressure ulcer-associated deaths than in matched controls. Pressure ulcer-associated mortality was higher among blacks than among whites (age-adjusted rate ratio, 4.22; 95% CI, 4.16-4.27).

Conclusion: Pressure ulcers are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the United States. Incapacitating chronic and neurodegenerative conditions are common comorbidities, and mortality rates in blacks are higher than in other racial/ethnic groups.