Changing Epidemiology and Healthcare-Seeking Patterns of Chronic Wounds Over Two Decades: A Community-Based Comparative Study from India

Background Chronic wounds represent a significant public health challenge because of their prolonged healing time, associated morbidity, impaired quality of life, and substantial healthcare costs. Despite the growing burden of chronic wounds in low- and middle-income countries, longitudinal community-based data evaluating temporal changes in wound epidemiology remain limited in India. This study aimed to compare the prevalence, epidemiological profile, and healthcare-seeking behaviour associated with chronic wounds in two communities of Varanasi, Uttar Pradesh, over a 20-year period. Materials & Methods A community-based cross-sectional observational study was conducted between June 2022 and December 2023 in the Sunderpur and Kandwa communities of Varanasi district, Uttar Pradesh, India. A total of 10,003 individuals were surveyed using a pretested semi-structured questionnaire and clinical examination. Demographic characteristics, wound aetiology, anatomical distribution, associated comorbidities, and healthcare-seeking behaviour were recorded. Findings were compared with those of a community-based epidemiological study conducted in the same communities in 2003 ( n = 6917). Statistical analyses were performed using descriptive and comparative methods, with p < 0.05 considered statistically significant. Results Nineteen individuals were identified with chronic wounds, yielding an overall prevalence of 1.89 per 1000 population. Urban and rural prevalence rates were 1.57 and 2.64 per 1000 population, respectively. This represented a significant decline compared with the prevalence reported in 2003 (15.03 per 1000 population; p < 0.00001). Compared with 2003, the pattern of wound onset shifted from predominantly traumatic (82.7%) to predominantly spontaneous presentations (84.2%). Lower extremity wounds constituted the majority of cases (89.4%). Diabetic foot ulcers and neglected traumatic wounds were the leading aetiologies, each accounting for 36.8% of chronic wounds. Comorbidities were present in 57.9% of patients, with type 2 diabetes mellitus being the most common (47.4%). A marked change in healthcare-seeking behaviour was observed over the study period, with public-sector healthcare utilization increasing from 37.5% to 68.4%, while reliance on home remedies declined from 50.0% to 5.3%. Conclusions A substantial reduction in the prevalence of chronic wounds was observed in the studied communities over the past two decades. Chronic wounds continue to predominantly affect the lower extremities and remain closely associated with diabetes mellitus and neglected traumatic injuries. The observed shift toward formal healthcare-seeking behaviour may indicate improved healthcare accessibility and greater awareness regarding wound management within the community. Larger multicentric studies are warranted to confirm these findings and further characterize evolving wound epidemiology in India.