Global burden and epidemiological trends of pressure injuries from 1990 to 2021: comprehensive analysis from the Global Burden of Disease Study 2021

Background: This study aimed to analyze the global epidemiological trends of pressure injuries (PIs) from 1990 to 2021, focusing on mortality, prevalence and disability-adjusted life years (DALYs). By leveraging the Global Burden of Disease (GBD) 2021 data-set, we sought to identify sex- and age-specific patterns, temporal trends, and future trend prediction to inform targeted public health interventions. Methods: We extracted data from the GBD 2021 database, including prevalence, mortality and DALYs, stratified by age, sex, and location. Statistical analyses included joinpoint regression to identify temporal trends, age-period-cohort modeling to disentangle age, period, and cohort effects, frontier analysis to assess efficiency gaps relative to sociodemographic development, and ARIMA modeling to forecast future trends. Results: Globally, crude mortality increased from 0.31 (0.26–0.37) per 100,000 in 1990 to 0.47 (0.36–0.54) in 2021, with prevalence rising from 5.63 (5.08–6.25) to 8.18 (7.38–9.03). Disability burden also escalated, with DALYs increasing from 408,886.98 (329,846.87–490,564.17) in 1990 to 803,747.40 (612,264.19–903,732.23) in 2021. However, age-standardized rates declined: ASMR decreased from 0.53 (0.44–0.63) to 0.46 (0.35–0.51), ASPR from 8.24 (7.15–9.40) to 7.92 (7.10–8.80), and ASDR from 10.74 (8.86–12.74) to 9.70 (7.41–10.88) per 100,000. Sex-specific analyses revealed higher mortality number in females, peaking at 85–89 years, while males exhibited earlier peaks in disability burden at 70 years. Joinpoint regression identified an overall decreasing trend of ASMR (AAPC = − 0.47%), while ASPR (AAPC = − 0.13%) and ASDR (AAPC = − 0.31%) showed intermittent rises amid overall declines. Age-period-cohort analysis confirmed net declines in age-standardized rates, with 2004 marking a turning point for mortality reductions. Frontier analysis revealed persistent efficiency gaps, particularly in high-SDI countries like the U.S. and Singapore. ARIMA models projected continued but marginal declines by 2031 for both ASMR (0.45per 100,000) and ASDR (9.23 per 100,000), with similar trends for both sexes. Conclusions: Despite progress in age-standardized metrics, the absolute burden of PIs is escalating due to demographic aging. Targeted interventions must address geriatric populations, sex-specific vulnerabilities, and regional disparities. Policy priorities include scaling cost-effective prevention technologies, integrating PIs into universal health coverage, and optimizing resource allocation to bridge efficiency gaps.