Risk Factors for Community-Acquired Pressure Injuries: Findings from a Large-Scale Asian Case–Control Study

BACKGROUND Pressure injuries, also known as pressure ulcers, remain a major global health problem, causing significant clinical, economic, and psychosocial burdens despite advances in prevention and treatment. While most research has focused on hospital-acquired cases, community-acquired pressure injuries are increasingly recognised, with prevalence in some settings exceeding hospital-acquired rates. Evidence from Asian healthcare systems is limited, yet region-specific factors such as ageing populations, caregiver dependence, and variable access to wound care highlight the urgent need for contextualised prevention strategies. OBJECTIVE To identify the risk factors associated with pressure injuries that developed in the community among adults admitted to an acute care hospital. DESIGN Retrospective, unmatched case–control study SETTING Acute tertiary hospital PARTICIPANTS Electronic medical records from January 2021 to June 2022, which include 52,480 admissions (5,772 cases and 46,708 controls) METHODS The study was conducted using electronic medical records from January 2021 to June 2022. The cases were adults with community-acquired pressure injuries documented within 24 hours of admission; controls had no pressure injuries on admission. Descriptive statistics and effect sizes were used to summarise the relationships between the risk factors and community-acquired pressure injuries. Statistically significant predictors were identified and included in the multivariable logistic regression, and interaction terms were tested for potential effect modification. RESULTS Among 52,480 admissions, 5,772 were cases and 46,708 were controls. The most common site of injury was the sacrum/coccyx (51%). On univariate analysis, cases were older, more likely to be unemployed, and had greater functional limitations. Moist skin and diaper use were more prevalent, along with poorer nutritional and inflammatory profiles, including lower serum albumin levels and higher C-reactive protein levels. Independent predictors included unemployment, poor or inadequate nutrition, lower serum albumin, functional dependence, moist skin, hypertension, and a history of peptic ulcer disease. A significant interaction between albumin and sex indicated a modest sex-based difference in the association between albumin and pressure injury risk. CONCLUSION Community-acquired pressure injury risk is multifactorial, involving sociodemographic, functional, nutritional, and microclimate factors. Moisture exposure and mobility limitation were key predictors. A modest sex-based difference in the association between albumin and pressure injury risk was observed. Prevention strategies that integrate nutritional support, mobility optimisation, and moisture management may reduce the incidence of community-onset pressure injuries in ageing populations. REGISTRATION Not registered