Global Burden of Pressure Ulcer and Contributing Factors from 1990 to 2021: A Systematic Analysis with Forecasts to 2035

Objective: To analyze global trends in pressure ulcer (PU) burden, focusing on microbial infections, antimicrobial resistance (AMR), and climate change from 1990 to 2021, and to forecast location-specific disease burdens through 2035. Approach: This is a cross-sectional study on PU globally from 1990 to 2021. This analysis assessed incidence and disability-adjusted life-years (DALYs) of PU by age, sex, and location, focusing on the relationship between PU burden and microbial infections, AMR, and climate factors. Results: Incidence and DALYs of PU increased from 1990 to 2021, while the corresponding age-standardized rate (ASR) declined or remained steady. ASR of incidence was highest in high sociodemographic index (SDI) areas and lowest in those with low SDI, while ASR of DALYs showed the opposite pattern. PU burden positively correlated with microbial infections and AMR in skin and subcutaneous infections (p < 0.05), and its increase was also associated with high temperature and humidity. Regardless of age, males bear a greater disease burden. However, with aging, females gradually surpass males in disease burden. Innovation: This study offers decision-makers insights into PU burden, contributing factors, and forecasts, supporting informed policies to mitigate its impact. Conclusion: PU poses a rising global challenge with persistent disease burden, especially in low-SDI and low-income regions. Microbial infections, AMR, and climate factors are associated with increased burden. Targeted policies and enhanced epidemiological understanding are crucial for effective prevention and control.