Global burden of pressure injuries in aging populations and cost - effectiveness analysis of intervention measures in China.

Abstract

Pressure injuries remain a major preventable challenge in geriatric care, with their burden exacerbated by global population aging and inequities in healthcare access-particularly impacting low- and middle-income countries (LMICs) and vulnerable subgroups. Prior studies have focused on high-income regions or single-country cohorts, lacking comprehensive global analyses of burden trends and context-specific cost-effective interventions. This study aimed to 1) analyze the spatiotemporal patterns of pressure injury-related disability burden among adults aged ≥ 65 years across 204 countries from 1990 to 2021; 2) project future burden trends through 2035 using Bayesian modeling; and 3) evaluate the cost-effectiveness of pressure injury prevention interventions (pressure-redistribution devices [PRDs] and caregiver training programs [CTPs]) in China's aging cohort. Data on disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease (GBD) 2021 dataset via the Global Health Data Exchange (GHDx). Bayesian Age-Period-Cohort (BAPC) modeling with socioeconomic stratification (by Socio-Demographic Index, SDI) was used to estimate age-standardized DALY rates (ASDR) and project future burden. A probabilistic Markov decision model assessed the cost-effectiveness of standalone PRDs, standalone CTPs, and combined PRD+CTP interventions in China, incorporating local unit costs and GBD-derived disability weights. Between 1990 and 2021, absolute DALYs surged 130.8 % globally, though age-standardized rates showed modest decline. Sex disparities emerged: females accounted for 59 % of total DALYs in 2021, with slower ASDR declines [Estimated Annual Percentage Change (EAPC): -0.49 %] than males (EAPC: -0.75 %). In China, PRD+CTP interventions averted 231,840 DALYs yearly, saving $588 M in net healthcare costs over 5 years. Global pressure injury burden in aging populations is growing, with stark regional and sex disparities. The combined PRD and CTP interventions represent a cost-effective strategy for mitigating disease burden in China, thus potentially offering a scalable framework for LMICs.