Influence of race and neighborhood on the risk for and outcomes of burns in the elderly in North Carolina

Abstract

Risk factors for mortality and length of hospital stay in elderly burn patients are well established, but the influence of race and socioeconomic status has not been evaluated. This study evaluates the effect of neighborhood level socioeconomic indicators on burn injury risk determines whether race and neighborhood influence burn injury outcomes in the elderly. Data from the North Carolina Jaycee Burn Center was linked to United States Census Bureau block group socioeconomic data. The odds of death and increased length of hospital stay for Caucasians and Minorities were determined using logistic regression. Rates of burn injury were determined using Poisson regression and multilevel modeling was used to evaluate the influence of neighborhood on outcomes. No significant differences in mortality were observed between Caucasian and Minority patients in individual (Minority OR 0.71; p=0.3200) and multilevel (0.72; p=0.4020) models. Minorities had significantly higher odds of increased length of hospital stay in individual (2.05; p=0.0020) and multilevel (2.55; 0.037) models. High proportions of rural households (RR=1.39; p=0.0010) and poverty (1.26; p<0.0001) were significantly associated with increased risk of burn injury. Additional investigation using larger databases will allow further elucidation of the contextual effects of socioeconomic status on burn injury in the elderly.

Census-based socioeconomic indicators for monitoring injury causes in the USA: a review

“…Not all SES constructs are equally attributable to injury risk. We found that the likelihood of injury was more strongly associated with measures of relative poverty when measured in conjunction with the level of education, 31 32 40 but not when measured using median income. 32 40 Employment-related variables were more indicative of unintentional rather than intentional injury.…”

“…Two measures were variations on an area's proportion of lone parent families. 11 29 30 32 39 40 Other constructs included the ‘proportion of men’, 37 the ‘proportion of population ages 59 years or older’ 40 and the proportion of population having moved in the past 5 years. 31 Each measure was statistically significantly associated with injury when evaluated in pairwise comparisons or when aggregated into a composite index.…”

“… 29 34 39 41 42 The remaining constructs were either specific to housing structure 34 36 39 43 or zoning/rental status. 40 42 44 When evaluated, only 3 of the 14 pairwise (21%) evaluations of household overcrowding were associated with either injury risk or a social gradient in injury risk.…”

“… 11 28 30–32 34 35 37 38 40 42 45–53 Distributive measures of income were represented in seven different ways, such as concentrated poverty, 36 ratios of income distribution, 42 44 or using various percentages of populations or population groups below the poverty line. 11 28 32 34 37 40–42 52 54 55 Other frequently used constructs were measures of permanent income or wealth, such as car ownership or housing value. 11 42 When compared with rates of injury, distributive measures of income were significant in 22 of 26 comparisons, whereas measures of central tendency were significant indicators of injury risk in 23 of all 37 tests.…”

Home fire safety beliefs and practices in homes of urban older adults

“…2 Although aging in place is preferable to many older adults, the elderly are at a disadvantage when it comes to home fire safety (HFS) and are at increased risk for burns. 3,4 Fire prevention education has historically been focused on reaching school-aged children, and it has only been more recently that fire services/ departments have recognized older adults as a high risk population for home fires, making this a new focus in fire prevention. 2,3,5e8 Much of the research addressing HFS in the older adult population has centered on risk factors associated with fire and burn injuries.…”