Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects

OBJECTIVE: To examine age-period-duration patterns of the prevalence of pressure ulcers in community-residing people with spinal cord injury (SCI). DESIGN: Multicenter cohort study. SETTING: Nine Model Spinal Cord Injury Systems throughout the United States. PARTICIPANTS: People with SCI (N=3361) injured between 1986 and 1995 and followed up thereafter on a yearly basis through 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physician-confirmed pressure ulcers of stage II or greater at the follow-up visits. RESULTS: The multivariable generalized estimating equations model showed a significant trend toward increasing pressure ulcer prevalence in the recent years (1994-2002 vs 1984-1993: odds ratio=1.4; 95% confidence interval, 1.2-1.6) not explained by aging, years since injury, or demographic and clinical factors. The risk of pressure ulcers appeared to be steady during the first 10 years and increased 15 years postinjury. Pressure ulcers were more common among the elderly, men, African Americans, singles, subjects with education less than high school, unemployed, subjects with complete injury, and subjects with history of pressure ulcers, rehospitalization, nursing home stay, and other medical conditions. Injury cause and level had no significant effect. CONCLUSIONS: These results highlight the need for research into factors that contribute to the increasing pressure ulcer prevalence.