Global forecasts of decubitus ulcer burden among older adults across sociodemographic settings to 2030.

Decubitus ulcer is a largely preventable condition that disproportionately affects older adults and depends on pressure redistribution, wound care, infection control, nutrition, and care continuity. Mortality from decubitus ulcer may therefore provide a useful, although nonofficial, signal of health-system performance in aging populations. We estimated global trends and forecasts of incidence, mortality, and mortality-to-incidence ratio (MIR) among adults aged ≥60 years from 2010 to 2030. We conducted an ecological time-series analysis using Global Burden of Disease 2021 estimates for 204 countries and territories, grouped by Sociodemographic Index (SDI). Age-standardized incidence and mortality rates were calculated, and MIR was defined as mortality divided by incidence. "Sustainable Development Goal (SDG) 3.4-aligned progress" was used only as an analytical benchmark, not an official SDG indicator, and was defined as a ≥33.3% mortality reduction between 2015 and 2030. Incidence was modeled on the log scale and MIR on the logit scale using SDI-specific trends with country-level random intercepts. Mortality was derived as incidence × MIR. Observed SDI-level estimates for 2010 to 2021 used Global Burden of Disease uncertainty intervals, and forecasts for 2022 to 2030 used prediction intervals. All 204 countries and territories were included. Forecasts showed persistent SDI-related differences. High SDI settings had the highest incidence but lower mortality and MIR, whereas low and low-middle SDI settings had less favorable trajectories. At the SDI aggregate level, mortality in low-middle SDI settings increased from 3.4 per 100,000 in 2015 to 7.5 per 100,000 in 2030, with MIR increasing from 0.059 to 0.130. Low SDI settings also showed increasing mortality, from 4.1 to 5.7 per 100,000, and MIR, from 0.145 to 0.199. Only Kuwait, Georgia, and Kyrgyzstan were projected to achieve the benchmark. Projected reductions in decubitus ulcer mortality among older adults are likely to remain limited and uneven. MIR relates mortality to diagnosed burden and may help contextualize whether changes in recorded incidence are accompanied by changes in mortality relative to incidence. Decubitus ulcer mortality and MIR may characterize disparities in care continuity, but neither is an official SDG 3.4 indicator.