Burden and trends of decubitus ulcers in East Asia, 1990-2021, with projections to 2031: a comprehensive analysis of the global burden of disease study.

backgroundDecubitus ulcers (DUs) represent a substantial global public health challenge, significantly diminishing patient quality of life and increasing the incidence of infection and early mortality. Given the rapidly aging populations in major East Asian economies, including China, Japan, South Korea, and Taiwan (Province of China), a comparative analysis of the DU burden across these regions is lacking.

methodsLeveraging data from the Global Burden of Disease (GBD) 2021 study, this study quantified the epidemiological burden of DUs globally and specifically within China, Japan, South Korea, and Taiwan (Province of China) during the period 1990-2021. Analyses evaluated key metrics including incidence, mortality, and disability-adjusted life years (DALYs), presenting both absolute counts and age-standardized rates (ASRs). Temporal trends in these burden estimates were assessed using Joinpoint regression analysis to identify significant inflection points. Future burden projections were generated via autoregressive integrated moving average (ARIMA) modeling. Comprehensive stratification by sex, age group, geographical region, and temporal interval was performed throughout all analyses.

resultsBetween 1990 and 2021, the global disease burden of DUs escalated markedly, with incident cases surging by 116.03% to an estimated 2.5 million worldwide in 2021. China recorded the largest absolute increase, with cases rising from 163,510 to over 397,310 (+ 142.99%), alongside dramatic upticks in mortality (from 240 to 3,130 deaths, + 1188.89%) and DALYs (+ 417.70%). Japan and South Korea also experienced substantial growth in incidence (from 68,090 to 152,660 and 16,480 to 39,840, respectively) and mortality. Taiwan (Province of China) exhibited the highest relative increase in incidence (+ 194.53%, reaching 4,950 cases in 2021), though its overall disease burden remained comparatively modest. Age-standardized rate analyses revealed divergent trends: China was the sole region with significant increases in incidence, mortality, and DALY rates, whereas Taiwan (Province of China) demonstrated the most significant reductions, and both South Korea and global rates generally declined. Males exhibited a higher disease burden, particularly in China, and the elderly-especially those aged 80 and above-were at greatest risk, with demographic aging identified as a key contributing factor. Forecasts for the coming decade suggest a continued upward trajectory in total DU cases across all examined countries and regions, with China projected to experience the most pronounced absolute increase.

conclusionsDUs continue to represent a significant and escalating public health concern, especially within China. The increasing prevalence of an aging population serves as a primary catalyst, underscoring the urgent need for the deployment of regionally tailored and demographically stratified (notably by age and sex) healthcare policies and precision-based interventions. These results provide critical evidence to inform the optimization of DU management and the mitigation of geographic disparities. Subsequent research should prioritize the exploration of socioeconomic determinants and the enhancement of healthcare accessibility.