Increases in One-year Mortality Risk Among Chronic Skin Ulcer Patients During the Period 1980–2020

TL;DR

Chronic skin ulcer patients had a significantly higher risk of dying within one year compared to others, with the risk increasing over time, highlighting the need for better treatment and care.

Contribution

This study reveals a fourfold increased one-year mortality risk in chronic ulcer patients and identifies specific ulcer types and time periods with the highest risk.

Findings

Chronic ulcer patients had a 3.8-fold higher one-year mortality risk compared to matched references.

Vasculitic, arterial, and pyoderma gangrenosum ulcers were associated with the highest mortality hazard ratios.

Mortality risk increased over time for most ulcer types but decreased recently for vasculitic and pyoderma gangrenosum ulcers.

Abstract

Chronic ulcer patients often suffer from multiple comorbidities and may even face increased risk of death. This study investigated short-term mortality of 5,230 ulcer patients treated in tertiary healthcare between 1980 and 2020, and their 15,594 matched references. Hazard risks (HR) for mortality were compared between patients with venous, arterial, mixed, vasculitic, and pyoderma gangrenosum ulcers (PG) and between 4 x 10-year study periods. One-year mortality risk was increased among all ulcer patients over the whole study period (HR 3.8), and it was highest among patients with vasculitic (HR 8.5), arterial (HR 7.0), and PG (HR 6.6) ulcers. During the 4 study decades the mortality HR of all ulcer patients increased from 2.3 to 4.9. However, among patients with vasculitic and PG ulcers, mortality risk decreased between the last decades observed. Among causes of death, highest 1-year HR for mortality from underlying causes of death was diabetes (HR 31.6), and of selected immediate causes of death, mortality from sepsis was notably increased (HR 22.1). In conclusion, patients with chronic ulcers were at almost fourfold increased risk of 1-year mortality and the risk increased over time. The study stresses the need for a multidisciplinary approach and effective treatment of underlying conditions.

This study investigated the short-term mortality risk of patients with chronic ulcers 1980–2020. Patients were found to have an almost fourfold increased risk of 1-year mortality, the risk being highest among those with vasculitic and arterial ulcers. Short-term mortality risk seemed to increase over time, except that among patients with pyoderma gangrenosum (PG) and vasculitic ulcers a recent decline in mortality was detected. Patients were notably at risk of death from diabetes, digestive, and ischaemic heart diseases. Therefore, a multidisciplinary approach and effective treatment of underlying long-term illnesses is crucial.

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