Mortality trends of pressure ulcers and non-healing wounds in the United States, 1999–2024
Haifa Alfalah, Haifa K. Alqahtani, Nawarah Alsayed, Luluh Alomaym, Norah Alkahtani, Atif Bakr Atif Sindi, Najed Alriyaee, Abdulrahman Abdulmajeed Alquzi, Reema Abdulrahman Alamri, Fay Naif Abdullah Alanazia, Raghad Alharbi, Laksh Kumar, Adarsh Raja, Aayush ChaulagainBackground:
Pressure ulcers (PUs) and chronic non-healing wounds (NHWs) are important causes of morbidity and mortality, particularly among older adults with multimorbidity. The two conditions arise through different mechanisms but are frequently reported together, which can conceal their separate trajectories. This study assessed 26 year national trends in wound-associated mortality in the United States, analyzing each condition on its own.
Methods:
We conducted a retrospective analysis of CDC WONDER mortality data from 1999 to 2024. PUs were defined by ICD-10 code L89, and chronic NHWs by L97 or L98.4. Each group was analyzed as a separate primary outcome rather than as a single pooled indicator. Age-adjusted mortality rates (AAMRs) and crude mortality rates per 100 000 were calculated using the 2000 US standard population. Temporal trends were assessed with Joinpoint regression, using a grid search from zero to three joinpoints with permutation-based model selection. Demographic and geographic subgroup rates are reported for the whole wound-associated decedent population because cell suppression prevents stable code-specific estimates within small strata.
Results:
PUs were recorded on 255 054 death certificates (AAMR: 2.8 per 100 000; 95% CI: 2.7 to 2.9) and chronic NHWs on 69 230 (AAMR: 0.7; 95% CI: 0.7 to 0.7). Only 5834 decedents (1.8%) carried codes from both groups. Annual PU deaths rose 1.3-fold, from 9154 in 1999 to 12 016 in 2024, with a peak of 13 411 in 2022, whereas NHW deaths rose 2.6-fold, from 1792 to 4703. The NHW share of wound-associated deaths grew from 16.5% to 28.6%. NHW mortality increased steadily from 2012 onward, with the AAMR rising from 0.6 to 1.1 per 100 000 (APC: 5.64%;
Conclusions:
PU and chronic NHW mortality followed opposite courses over 26 years, which argues against reporting them as a single pooled indicator. NHW mortality rose steadily and now accounts for a growing share of wound-associated deaths. Differences by race, region, and urbanization persisted throughout the period. These descriptive findings support prevention strategies aimed at each condition separately and at improved access to wound care services, and they should be read as associations rather than as causal effects.