# Trends, Drivers and Projections of Pressure Injury Burden in China: Implications for National Healthcare Policy and Aging Governance

## TL;DR

This study analyzes how pressure injuries in China have increased due to aging and suggests policy changes to address the growing burden on healthcare.

## Contribution

First comprehensive national-level study using GBD 2021 data and advanced models to assess pressure injury burden in China.

## Key findings

- Population aging is the main driver of pressure injury burden, accounting for 46.5%–65.0% of the increase.
- Gender disparities show men with higher burden in middle age, while women surpass men in very old age.
- Future projections predict a 127% increase in deaths by 2040 despite declining total prevalence.

## Abstract

Pressure injuries represent a significant public health challenge in the context of global population aging. As China faces rapid aging, the characteristics of its disease burden and the strategies for prevention and control remain unclear. This study analyses the trends in the disease burden of pressure injuries in China over the past 30 years, based on the Global Burden of Disease (GBD) 2021 data, and predicts the future trends over the next 20 years. The GBD 2021 data were used in combination with the Joinpoint regression model, age‐period‐cohort (APC) model and Bayesian age‐period‐cohort (BAPC) model to analyse the burden of pressure injuries in China from 1990 to 2021 and forecast trends from 2022 to 2040. Additionally, decomposition analysis was performed to quantify the contribution of population aging to the disease burden. In 2021, the number of people with pressure injuries in China was 102 938.9, the number of new cases was 397 312.3, the disability‐adjustede life years (DALYs) totaled 27 383.5 and the number of deaths was 3131.5. The gender difference was characterised by ‘higher prevalence in middle‐aged men, with a reversal in very old women’. Between 1990 and 2021, the burden of pressure injuries significantly increased, with population aging being the main driving factor (46.5%–65.0%). The cohort effect indicated a higher risk for those born before 1942 (RR = 1.04–1.86), and a decreasing risk for those born after 1960 (RR = 0.91). Future projections suggest a 25.8% decrease in total cases, but an increased burden in those aged 85 and older, with deaths rising by 127%. This study highlights the aging‐driven burden of pressure injuries in China, along with gender differences and typical period and cohort effects. As the population ages, the burden of pressure injuries in older age groups will continue to rise. The findings provide evidence for the ‘Healthy China 2030’ initiative and call for the inclusion of pressure injury prevention and control in the core agenda of national aging governance.

First comprehensive national‐level study to assess the long‐term disease burden of pressure ulcers in China using GBD 2021 data and multiple advanced statistical models.Significant increase in pressure ulcers burden from 1990 to 2021, with age‐standardized DALY and death rates rising by 117.6% and 100%, respectively, indicating worsening severity despite stable incidence and prevalence trends.Population aging identified as the primary driver, accounting for 46.5%–65.0% of the increase in disease burden, especially in the 85+ age group, highlighting a key public health challenge in China's super‐aging transition.Marked gender disparities observed: men had higher burden in middle age, while women surpassed men in very old age, reflecting gender‐specific risk patterns and implications for targeted intervention.Distinct period and cohort effects revealed by APC models, with peak burden observed in 2009 and among cohorts born before 1942, possibly linked to historical trauma and healthcare access disparities.Future projections using the Bayesian APC model predict a 127% increase in deaths by 2040, despite a decline in total prevalence and incidence—indicating a “scissors gap” where burden increasingly concentrates among the elderly.Current prevention systems are inadequate for managing pressure ulcers in an aging society; urgent need for policy reform, AI‐enabled community interventions, and elderly‐specific care strategies.Proposes establishment of a national “Elderly Pressure Ulcer Prevention Fund” and integration of pressure ulcer management into China's Healthy Aging and Healthy China 2030 strategies.

First comprehensive national‐level study to assess the long‐term disease burden of pressure ulcers in China using GBD 2021 data and multiple advanced statistical models.

Significant increase in pressure ulcers burden from 1990 to 2021, with age‐standardized DALY and death rates rising by 117.6% and 100%, respectively, indicating worsening severity despite stable incidence and prevalence trends.

Population aging identified as the primary driver, accounting for 46.5%–65.0% of the increase in disease burden, especially in the 85+ age group, highlighting a key public health challenge in China's super‐aging transition.

Marked gender disparities observed: men had higher burden in middle age, while women surpassed men in very old age, reflecting gender‐specific risk patterns and implications for targeted intervention.

Distinct period and cohort effects revealed by APC models, with peak burden observed in 2009 and among cohorts born before 1942, possibly linked to historical trauma and healthcare access disparities.

Future projections using the Bayesian APC model predict a 127% increase in deaths by 2040, despite a decline in total prevalence and incidence—indicating a “scissors gap” where burden increasingly concentrates among the elderly.

Current prevention systems are inadequate for managing pressure ulcers in an aging society; urgent need for policy reform, AI‐enabled community interventions, and elderly‐specific care strategies.

Proposes establishment of a national “Elderly Pressure Ulcer Prevention Fund” and integration of pressure ulcer management into China's Healthy Aging and Healthy China 2030 strategies.