Outcomes of Pressure Ulcer Injuries Classified by Race: A 10-Year Nationwide Analysis

Pressure ulcer injuries (PIs) are ischemic changes to the skin caused by long-term pressure on bony prominences. This study aimed to investigate the prevalence of PIs and their effects on minority groups in the hospital setting in the United States.

The National Inpatient Sample (NIS) from 2011 to 2020 was used to identify adults hospitalized in the United States who received a diagnosis of PI. International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to select patients. An equal number of random records, stratified by year and without a diagnosis of PI, were selected to serve as controls. Records were analyzed for baseline characteristics using a chi-square test.

Adjusted odds ratios (ORs) of developing a pressure ulcer were calculated using multivariate logistic regression, a weighted total of 5,993,667 PI admissions were included in this study, and 5,993,667 non-PI admissions were included. PI patients were more likely than controls to be male (OR = 0.88; 95% confidence interval {CI}: 0.88, 0.89; p < 0.05). PI patients were more likely to be older than non-PI patients (75+ years; OR = 3.46; 95% CI: 3.38, 3.54; p < 0.05). PI patients were more likely to be on Medicare or Medicaid (OR = 1.94; 95% CI: 1.92, 1.97; p < 0.05) than private insurance. PI patients were far more likely to have a high Charlson Comorbidity Index (CCI) of 3+ (OR = 10.44; 95% CI: 10.18, 10.71; p < 0.05) than a lower CCI score. Compared to Whites, African Americans (OR = 1.49; 95% CI: 1.47, 1.51; p < 0.05) were at higher risk of PIs. Among PI patients, White patients had a lower risk of death compared to African Americans (OR = 1.09; 95% CI: 1.07, 1.11; p < 0.05). African Americans had lower rates of acute kidney injury (AKI) compared to Whites (OR = 0.88; 95% CI: 0.86, 0.91; p < 0.05). Compared to Whites, rates of sepsis were higher for African Americans (OR = 1.40; 95% CI: 1.38, 1.42; p < 0.05).

A racial discrepancy in pressure ulcer prevalence was shown in racial minorities, particularly African Americans. It is essential to address this difference in diagnosis to improve outcomes among racial minorities.