A National Study of the Effect of Race, Socioeconomic Status, and Gender on Burn Outcomes

Abstract

Age, burn size, and inhalation injury are the major contributing variables related to burn mortality. While the female gender has been linked to higher mortality, the impact of socioeconomic status has not been well studied. The interplay between these three factors is also unknown. This study sought to clarify the effects of these variables on outcomes in a national sample of patients with burns. A retrospective review of 172,640 patient records of the National Burn Repository (version 8, 2002-2011) data was conducted. Of those records, 36,960 (21.4%) patient entries were excluded for duplicate entries, follow-up visits, readmissions, nonburn injuries, skin diseases, and incompleteness (missing date of admission, date of discharge, race, or TBSA of burn or TBSA). Univariate and multivariate analyses were performed to compare outcomes by race (Caucasian, African-American, and other minority groups). P < .05 was considered significant. The study group included 135,680 patients and was predominately Caucasian (59.0% Caucasian, 19.0% African-American, and 22.0% other minority groups). The African-American race had more females, operations, longer length of stay, ventilator days, septicemia (all P < .001), and urinary tract infections (UTIs, P < .01). Caucasians had the largest burns (9.27 ± 13.22, P <.001) and were more likely to be older, to be intubated, and to have longer intensive care unit stays and higher mortality (all P < .001). Other non-African-American minorities (other minority group) had the second largest burn sizes, most uninsured members, and lowest mortality (P < .001). On multivariate analysis, mortality was related to African-American race, female gender, TBSA, full-thickness burn injury, inhalation injury, uninsured status, and burn mechanism. African-Americans were 50% more likely to have complications (P < .001), 30% more likely to have UTIs (P = .002), and 41% more likely to get septicemia (P < .001). Other racial minority groups had more acute respiratory distress syndrome, pneumonias, septicemia, UTIs, length of stay, and hospital charges when compared with Caucasian patients. Socioeconomic status was related to mortality but inconsistently related to other outcomes. Race appears to play a significant role in burn injury outcomes. Minority groups, especially African-Americans, have a higher risk of morbidity and mortality compared with Caucasian patients with burns. Socioeconomic status and gender also play a significant role in burn outcomes. Future studies should focus on delineating the reasons for this disparity.

Multi-institutional analysis of independent predictors for burn mortality in the United States

“…The current database literature examining the risk factors for morbidity and mortality after burns typically focuses on specific variables, such as age, gender, or socioeconomic status [ 6 , 10 , 11 ]. In these cases, the true risk amplification, which is illustrated by the OR and respective 95% CI, may be distorted if the multivariable analysis is not broad enough to include variables, such as comorbidities and in-hospital complications.…”

“…Carr et al have reviewed the NBR from 1998 to 2007 to determine the outcomes in burn patients with inhalation injury complicated by pneumonia [ 5 ]. Bedri et al demonstrated higher mortality rates after burn injuries associated with lower socioeconomic status, female gender, and African-American race [ 6 ]. Osler et al used the database to create a logistic regression model that showed how age, burned surface area, and inhalation injury contributed to mortality.…”

“…Age, burn size, and inhalation injury have been repeatedly reported as contributors to unfavorable outcomes [ 5 , 6 , 8 ]. However, we intended to expand on these studies and evaluate the importance of other factors as well.…”

Predictors of Early Onset Multiple Organ Dysfunction in Major Burn Patients with Ventilator Support: Experience from A Mass Casualty Explosion

“…Around 15% of patients with burns need invasive ventilator support, and their treatment outcomes could be even worse 19 . Considering the critical role of MODS in the treatment outcomes of patients with major burns, understanding the predictors of early MODS in patients with major burns would be helpful to clinicians in identifying high-risk patients who require the most intensive and aggressive management, particularly those with ventilator support.…”

The Patenting of Products and Processes Used for the Treatment of Smoke Inhalation

“…It is known, however, that the best clinical outcome for the victim of inhalation injury depends on other factors. According to Bedri et al [22], socioeconomic and ethnic factors and the sex of the victims influence the clinical outcome. They found that Afro-descendent Americans, female and uninsured, had more complications, more surgical interventions, longer hospital stay, and higher mortality rates, even though lower body surface area burned and there is a lower proportion of inhaled lesion.…”