Baylor University Medical Center, Dallas, TX
Hospital-Acquired Pressure Ulcer: Association With Population Disparities

Background: The hospital-acquired conditions (HACs) rate was 121 per 1,000 hospital discharges, and hospital-acquired pressure ulcers (HAPUs) occurred at a rate of 32.5 per 1,000 hospital discharges, accounting for 26.9% of the total HACs. A 2010 study suggested older patients and African American patients had a higher incidence of HAPUs. This project was designed to examine whether factors such as race, ethnicity, socioeconomic status, or gender could potentially contribute to the development of HAPUs.

Methods: The Midas/Datavision database was queried for the incidence of HAPUs (all stages) in inpatients >15 years from October 1, 2012 through September 30, 2015. Variables examined include self-reported demographics (age, gender, race [African American vs Caucasian], ethnicity [Hispanic vs non-Hispanic]), insurance status (insured vs self-pay), median income by ZIP code, length of stay (LOS), medical vs surgical diagnosis-related group (DRG), risk of mortality (ROM), and certain comorbidities: congestive heart failure, obesity, weight loss, diabetes with complications, coagulopathy, paralysis, chronic pulmonary disease, and fluid/electrolyte abnormalities. Logistic regression was used to assess the effect of the variables of interest on the odds of developing HAPUs. Odds ratios and 95% confidence intervals were derived for each of the covariates in the logistic module.

Results: Overall, the risk of HAPU in the population studied was less than the national average. On initial statistical analysis, the HAPU incidence was associated with increased age, diabetes with complications, weight loss, fluid and electrolyte disorders, coagulopathy, surgical DRG, increased LOS, and increased ROM. On subanalysis, subtle differences emerged in the data based on demographic factors and DRG. HAPUs were statistically associated on subset analysis with race, gender, and medical diagnoses. There was an increased risk of HAPU in African American patients compared with Caucasian patients in the medical population based on DRG, as well as a decreased risk of HAPU in females in the medical population based on DRG. There was an increased risk of HAPU development in females in the surgical population based on DRG. There was no difference in HAPU incidence in Hispanics vs non-Hispanics, self-pay vs insured, or median income based on ZIP code data.

Conclusion: Disparities in the incidence of HAPUs were seen on subanalysis of demographic and DRG data points, with an increased risk of HAPU in African American vs Caucasian patients in medical DRGs and in females with surgical DRGs. At-risk populations can potentially be targeted for further interventions for HAPU prevention.