Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.