Recorded presentation

Matthew Redelings, MPH¹, Nolan Lee, MD, MPH², and Frank Sorvillo, PhD¹. (1) Data Collection and Analysis Unit, Los Angeles County Department of Health Services, 313 N. Figueroa St. Rm 127, Los Angeles, CA 90012, 213-240-7760, mredelings@dhs.co.la.ca.us, (2) Epidemiology Program Office, Epidemic Intelligence Service assigned to the Los Angeles County Department of Health Services, Centers for Disease Control and Prevention, Atlanta, GA 30333

Objectives Pressure ulcers are a common preventable condition among elderly persons. Although some emphasis has been placed on pressure ulcer prevention, pressure ulcers have not traditionally been viewed as an important cause of death. We examined pressure ulcer mortality in the United States during 1990–2000. Methods Pressure ulcer-related deaths were identified from national multiple cause-coded death records for 1990–2000 using ICD-9 code 707.0 and ICD-10 code L89. Denominator data were obtained from yearly census estimates. Crude and age-adjusted mortality rates were calculated for each age group, sex, and racial/ethnic group. Results During 1990–2000, pressure ulcers were reported as a cause of death among 105,734 persons (age-adjusted mortality rate = 3.88 per 100,000 population; 95% confidence interval [CI] = 3.86–3.91). For 19,727 (18.7%) of these deaths, pressure ulcers were reported as the underlying cause. Septicemia was reported in 74.9% of deaths with pressure ulcers identified as the underlying cause. Other frequent comorbid causes of death included cerebrovascular disease (19.5%), ischemic heart disease (16.1%), pneumonia (15.4%) and Alzheimer’s disease (11.0%). Pressure ulcer mortality was higher in blacks than in whites (age-adjusted rate ratio = 4.31, 95% CI = 4.26–4.37). By regression analysis, mortality rates decreased 4.4% per year (95% CI = 3.6%–5.2%). Discussion Pressure ulcers can lead to fatal secondary infections such as septicemia and are an important cause of preventable mortality in the United States. Chronic and incapacitating conditions are common comorbidities. Higher mortality rates in blacks suggest discrepancies in access to quality long-term care.

Learning Objectives: Participants of this session will learn to

• Appreciate that pressure ulcers are far more fatal than is generally understood.
• Explain mechanisms by which pressure ulcers can lead to death.
• Identify demographic and patient groups at high risk of death from pressure ulcers.
• Target elders in demographic groups at high risk of death from pressure ulcers for prevention efforts.
• Explain why pressure ulcer mortality rates can be used as a proxy for access to long term care in the elderly.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation