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Aims <p>This study examined long-term trends in the documentation of pressure injuries (PIs) on death certificates in the United States from 1999 to 2021. We evaluated demographic, geographic, and clinical patterns associated with PI documentation and explored whether state-level healthcare expenditure and nursing unionization were linked to observed trends.</p> Methods <p>Using CDC WONDER multiple cause-of-death data, we calculated age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) for deaths in which PIs were listed as an underlying or contributing cause. Trends were assessed across demographic and geographic subgroups. Exploratory ecologic analyses examined correlations between state-level healthcare expenditure, nursing unionization measures, and PI-related AAMRs.</p> Results <p>A total of 216,717 deaths listed PIs among the causes of death during the study period. Overall AAMRs declined from 5.20 per 100,000 in 1999 to 3.12 in 2021, with a marked increase between 2019 and 2021 (APC: 15.14%). Higher AAMRs were observed among non-Hispanic Black individuals, residents of southern states, and decedents with cardiovascular, neurodegenerative, or cerebrovascular comorbidities. No significant associations were found between PI-related AAMRs and state-level healthcare expenditure or nursing unionization.</p> Conclusions <p>National patterns of PI documentation on death certificates reveal persistent demographic and regional disparities. As PIs are rarely an underlying cause of death, these trends likely reflect broader patterns of frailty, comorbidity, and care complexity. Cautious interpretation is warranted, and future studies incorporating patient-level clinical data are needed to clarify mechanisms and guide prevention strategies.</p>

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National trends in deaths with documented pressure injuries in the United States from 1999 to 2021

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月10日

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  • Muhammad Ahrar Bin Naeem,
  • Eman Jawed,
  • Mishal Asif,
  • Nouman Amjad,
  • Sophia Ahmed,
  • Misal Jawed,
  • Abdur Rehman Khalid,
  • Smak Ahmed,
  • Farooq Ahmad

摘要

Aims

This study examined long-term trends in the documentation of pressure injuries (PIs) on death certificates in the United States from 1999 to 2021. We evaluated demographic, geographic, and clinical patterns associated with PI documentation and explored whether state-level healthcare expenditure and nursing unionization were linked to observed trends.

Methods

Using CDC WONDER multiple cause-of-death data, we calculated age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) for deaths in which PIs were listed as an underlying or contributing cause. Trends were assessed across demographic and geographic subgroups. Exploratory ecologic analyses examined correlations between state-level healthcare expenditure, nursing unionization measures, and PI-related AAMRs.

Results

A total of 216,717 deaths listed PIs among the causes of death during the study period. Overall AAMRs declined from 5.20 per 100,000 in 1999 to 3.12 in 2021, with a marked increase between 2019 and 2021 (APC: 15.14%). Higher AAMRs were observed among non-Hispanic Black individuals, residents of southern states, and decedents with cardiovascular, neurodegenerative, or cerebrovascular comorbidities. No significant associations were found between PI-related AAMRs and state-level healthcare expenditure or nursing unionization.

Conclusions

National patterns of PI documentation on death certificates reveal persistent demographic and regional disparities. As PIs are rarely an underlying cause of death, these trends likely reflect broader patterns of frailty, comorbidity, and care complexity. Cautious interpretation is warranted, and future studies incorporating patient-level clinical data are needed to clarify mechanisms and guide prevention strategies.