Increases in One-year Mortality Risk Among Chronic Skin Ulcer Patients During the Period 1980-2020

Chronic ulcer patients often suffer from multiple comorbidities and may even face increased risk of death. This study investigated short-term mortality of 5,230 ulcer patients treated in tertiary healthcare between 1980 and 2020, and their 15,594 matched references. Hazard risks (HR) for mortality were compared between patients with venous, arterial, mixed, vasculitic, and pyoderma gangrenosum ulcers (PG) and between 4 x 10-year study periods. One-year mortality risk was increased among all ulcer patients over the whole study period (HR 3.8), and it was highest among patients with vasculitic (HR 8.5), arterial (HR 7.0), and PG (HR 6.6) ulcers. During the 4 study decades the mortality HR of all ulcer patients increased from 2.3 to 4.9. However, among patients with vasculitic and PG ulcers, mortality risk decreased between the last decades observed. Among causes of death, highest 1-year HR for mortality from underlying causes of death was diabetes (HR 31.6), and of selected immediate causes of death, mortality from sepsis was notably increased (HR 22.1). In conclusion, patients with chronic ulcers were at almost fourfold increased risk of 1-year mortality and the risk increased over time. The study stresses the need for a multidisciplinary approach and effective treatment of underlying conditions.