Abstract
Introduction:
Residential fires account for the majority of burn-related injuries and fatalities. Established risk factors for burn injury include male gender, racial minority, children and elderly individuals, poverty, and substandard housing characteristics. In North Carolina, the rate of residential fire injuries and deaths is higher than the national average. Therefore, we sought to describe residential fire hospitalizations at a large regional burn center and describe the neighborhoods in which they live. We hypothesized that patients living in areas with higher Area Deprivation Index (ADI) are more likely to have major residential burns.
Methods:
We conducted a retrospective analysis of burn admissions from January 2002 – December 2015. We dichotomized patients into two cohorts: residential and non-residential burns and performed a bivariate analysis. Multivariate Poisson regression models were utilized to determine if ADI was associated with inhalation injury and ≥ 20% total body surface area burn.
Results:
Of the 10,506 patients presented during the study period. Of these, 10,016 (95.3%) patients resided in North Carolina, and 7,894 (78.8%) had a residential burn. Of the overall cohort, 6.0% (n = 458) of patients had ≥20% TBSA burns and 6.4% (n = 506) had inhalation injury. The majority of patients were in the highest (most disadvantaged) ADI quartile (n = 3050, 39.5%), and only 6.8% of patients (n = 525) were in the lowest (least disadvantaged) ADI quartile. In the Poisson multivariate regressions to determine if the ADI was associated with severe burns, patients in the highest ADI quartile had an increased relative risk of ≥ 20% TBSA burn (RR 1.31, 95% CI 1.02 – 1.68) and inhalation injury (RR 1.39, 95% CI 1.09 – 1.76) when compared to patients in the second-lowest ADI quartile when controlled for pertinent covariates.
Conclusion:
Residential structure fires represent the major source of burn injuries and fatalities. People who reside in the highest ADI quartile are more like to present with higher burn injury severity in terms of burn size and the presence of inhalation injury. The use of the ADI to target neighborhoods for burn prevention is imperative.
Keywords: Burns and Poverty, Burn Severity and poor neighborhoods, Burn severity and area deprivation index
Introduction
In 2016, there were an estimated 40,000 hospitalizations related to a burn injury resulting in 3,275 fire and smoke inhalation deaths in the United States (US).[1] Historically, residential structures have been the source of the majority of fire-related injuries and deaths, which currently remains true.[2–8] According to the US Fire Administration, an estimated 364,300 residential building fires occurred in 2016.[9] This estimate reflects a decrease in the number of fires and related injuries since 2007; however, there was an associated increase in fire fatalities between 2007 and 2019. In addition to the loss of life, the economic cost of residential building fires in the US is significant. The National Fire Protection Association estimates that in 2017 the fire service responded to over 1.3 million fires that caused $23 billion in property damage. [10]
The characteristics of individuals involved in residential structure fires have been previously investigated. Risk factors for injury include male sex, children and the elderly, and being African American, Hispanic or Native American.[11],[12] Although there are regional variations in residential burn incidence across the US, most injuries and deaths occur in the Southern region of the country.[13–15] Impairment by alcohol or other drugs, physical disability, and patients living in neighborhoods with high poverty have been identified as risk factors for residential fire injuries and fatalities.[16–18]
Unfortunately, traditional poverty markers, such as median household income and living below the federal poverty line, do not truly capture the essence of a residential neighborhood. The Area Deprivation Index (ADI) was designed to overcome this limitation. The index takes into consideration income, education, employment, and housing quality and ranks neighborhoods nationally. The association between burn severity, as determined by percent total surface (%TBSA) of burn, and the presence of inhalation injury with residential neighborhood characteristics are not well delineated. We hypothesize that there is an increased burn injury severity in patients who reside in neighborhoods with a highly disadvantaged ADI. [19]
In North Carolina (NC), in 2016, residential fires accounted for 31.8 injuries and 6.6 deaths per 1,000 fires. [20] This figure was higher than the national average of 24.4 injuries and 6.0 deaths per 1,000 fires that same year. Therefore, we sought to evaluate the risk of North Carolinians presenting with major burns following residential fires by National ADI, resulting in admissions to our regional burn center from 2002 to 2015.
Methods
We performed a retrospective analysis of the University of North Carolina (UNC) Jaycee Burn Center surveillance registry of patients presenting acutely from January 2002 to December 2015. The UNC Jaycee Burn Center is an American Burn Association verified burn center for pediatric and adult care. It is a 36-bed facility that averages over 1,600 acute admissions annually. The registry is maintained prospectively, and patients are captured upon admission. We included patients’ demographics and social history, burn characteristics, and outcomes in the database. Burn injury characteristics obtained include burn etiology, percentage total body surface area (%TBSA) involved, presence of inhalation injury, and use of mechanical ventilation during admission. Patients’ social history, including smoking, alcohol, and drug abuse/use history, were captured.
In this study, we included patients if they had a residential burn and lived in North Carolina. Residential burns were defined by the injury location codes “home” and “residential institution” while non-residential burns were all other injury locations (i.e. “farm”, “street”, “public building”, “recreation”, “other”). We excluded patients if they lived outside North Carolina. The primary outcomes of interest were burns >20% TBSA and the presence of inhalation injury.
The race covariate was categorized race into white, black, and others (including Hispanic, American Indian, and Asian patients). We categorized burn etiology into three groups: flame, scald, and others. We ascertained the diagnosis of inhalation injury based on history, physical examination, and bronchoscopic examination. We controlled for the effect of pre-existing comorbidities on mortality using the Charlson Comorbidity Index (CCI).[21] We calculated the CCI score for each patient. The standardized Charlson Index has been reported to accurately predict the probability of mortality within one year for several medical conditions. The score is the weighted sum of comorbid conditions. There are 17 comorbid conditions included in the score, and each is assigned a weight from 1 to 6 points. The weighted sum of all comorbid conditions is the patient’s CCI.
We geocoded residential locations utilizing ArcGIS (Esri, Redlands, CA). Residential geocoded locations were matched with their corresponding Federal Information Processing Standards (FIPS) numbers, corresponding to United States Census Block Groups, and merged with Area Deprivation Index (ADI) national percentile rankings from 1 to 100. The ADI was originally created by the Health Resources and Services Administration and has been refined and validated at the Census block group level. The ADI includes seventeen education, employment, housing-quality, and poverty measures originally drawn from long-form Census data and updated to incorporate more recent American Community Survey (ACS) data. It is a comprehensive measure of neighborhood disadvantage that could influence health care outcomes. [22] The 1st and 100th percentile correspond to the least and most disadvantaged ADI, respectively. We categorized national percentile ADI rankings into quartiles for analysis.
We performed univariate analysis to determine data distribution and missing variables. There was less than 3.0% missing data in all covariates of interest. The ADI was missing in 2.2% of patients included. This was a combination of missing addresses (1.6%) and suppressed ADI national ranking. ADI national ranking for neighborhoods can be suppressed because there are low population or housing, high group quarters population, or both. [22] We compared baseline patient and injury characteristics between ≥ 20% TBSA burn and <20% TBSA burn and the presence or absence of inhalation injury. We performed a bivariate analysis with chi-squared for discrete variables and Student T-test and Kruskal-Wallis for normally and non-normally distributed continuous variables, respectively.
To determine if the patient’s ADI is associated with a ≥ 20% TBSA burn, we performed a Poisson multivariate regression. Patient sex, age, ADI, race, burn injury mechanism, alcohol, drug, and tobacco use history were included in the regression a priori. On bivariate analysis, CCI was a significant patient factor with a p<0.05 and included in the full model. We reduced the model in a backward elimination approach. Removing sex, race, and alcohol use variables as their removal did not significantly change the risk ratio (<10%) and narrowed the confidence interval.
To determine if the patient’s ADI is associated with inhalation injury, we performed Poisson multivariate regression in the manner described above. We included sex, age, ADI, race, burn injury mechanism, alcohol, drug, and tobacco use history variables in the regression a priori. CCI was added based on its significance on bivariate analysis to complete the full model. In the final model, we removed sex and CCI variables on backward elimination. We performed all analyses using Stata IC v.16.0 (StataCorp, College Station, TX) and map creation using Tableau Public 2020.1 software. The University of North Carolina Institutional Review Board approved this study.
Results
A total of 10,506 patients presented acutely to our burn center from 2002-2015. Of these, 10,016 (95.3%) patients resided in North Carolina, and 7,894 (78.8%) had a residential burn, Figure 1. Overall the residential burn cohort was predominately male (n = 4913, 62.2%) with a mean age of 30.7 years (SD 24.0). Scald burns were the primary burn injury mechanism (n = 3705, 47.2%) with a median % TBSA of 3% (IQR 1.0 – 7.0). The majority of patients were in the highest (most disadvantaged) ADI quartile (n = 3050, 39.5%), and only 6.8% of patients (n = 525) were in the lowest (least disadvantaged) ADI quartile, Table 1. There was an overall 3.3% mortality for residential burns, with the greatest number of deaths occurring in the highest ADI quartile (n=109, 41.6 %), Figure 2.
Figure 1.
Inclusion and exclusion criteria
Table 1.
Baseline demographics and characteristics and outcomes of the residential burn cohort.
| All Residential Burn (n = 7,894) | |
|---|---|
| Male Sex: n (%) | 4913 (62.2) |
| Age (years): μ (SD) | 30.7 (24.0) |
| Race: n (%) | |
| White | 3704 (46.9) |
| Black | 2597 (32.9) |
| Other Minority | 1536 (19.5) |
| Population Classification: n (%) | |
| Rural | 5914 (76.3) |
| Urban | 1842 (23.8) |
| National Area Deprivation Index Quartiles: n (%) | |
| 0-24% | 525 (6.8) |
| 25-49% | 1715 (22.2) |
| 50-74% | 2429 (31.5) |
| 75-100% | 3050 (39.5) |
| Charleston Comorbidity Index: median (IQR) | 2 (2 – 2) |
| Uses Smoking Tobacco: n (%) | 1387 (18.3) |
| Drinks Alcohol: n (%) | 371 (4.8) |
| Illicit Drug Use: n (%) | 366 (4.7) |
| Burn Mechanism: n (%) | |
| Flame | 2920 (37.2) |
| Scald | 3705 (47.2) |
| Other | 1220 (15.6) |
| Total Body Surface Area Burn: median (IQR) | 3.0 (1.0 – 7.0) |
| Inhalation Injury: n (%) | 506 (6.4) |
| Ventilated: n (%) | 663 (8.6) |
| Intensive Care Unit Length of Stay (days): median (IQR) | 0 (0 – 1) |
| Hospital Length of Stay (days): median (IQR) | 5 (2 – 11) |
| Death: n (%) | 262 (3.3) |
Figure 2.
a: National Area Deprivation Index Quartiles in North Carolina
b: National Area Deprivation Index Quartiles of Burn Patients Presenting to the JC Burn Center
Of the overall cohort, 6.0% (n = 458) of patients had ≥20% TBSA burns. Median %TBSA in patients with ≥20% TBSA burns and <20% TBSA were 29.3% (IQR 23.0 – 44.0%) and 3% (IQR 1.0 – 6.0%), respectively. There was a male preponderance in both ≥20% TBSA and <20% TBSA cohorts. Patients with ≥20% TBSA were older (41.8, SD 24.5 vs. 30.0 years, SD 23.8, p<0.001) and more likely to drink alcohol (n=43, 9.5% vs. n=323, 4.5%, p<0.001) and use illicit drugs (n=38, 8.4% vs 321, 4.5%, p<0.001). The majority of patients in both the ≥20% TBSA burns and <20% TBSA cohorts were in the National 50 – 74% (n=146, 33.1% and n=2223, 31.4%, respectively) and 75 – 100% (n=191, 43.3% and n=2799, 39.6%) ADI quartiles, respectively Table 2. Crude death counts increased with increasing ADI quartiles, highest being in the top quartile but this was not statistically significant. Figure 3.
Table 2:
Demographics and Patient Characteristics in patients with ≥20% TBSA Burn and <20%
| ≥20% TBSA Burn (n=458, 6.0%) | <20% TBSA Burn (n= 7,234, 94.0%) | p-value | |
|---|---|---|---|
| Male Sex: n (%) | 301 (65.7) | 4484 (62.0) | 0.1 |
| Age: μ (SD) | 41.8 (24.5) | 30.0 (23.8) | <0.001 |
| Race: n (%) | 0.02 | ||
| White | 242 (53.0) | 3358 (46.8) | |
| Black | 142 (31.1) | 2396 (33.4) | |
| Other Minority | 73 (16.0) | 1425 (19.9) | |
| Population Classification: n (%) | 0.1 | ||
| Rural | 350 (79.4) | 5433 (76.3) | |
| Urban | 91 (20.6) | 1685 (23.7) | |
| National Area Deprivation Index Quartiles: n (%) | 0.1 | ||
| 0-24% | 23 (5.2) | 475 (6.7) | |
| 25-49% | 81 (18.4) | 1579 (22.3) | |
| 50-74% | 146 (33.1) | 2223 (31.4) | |
| 75-100% | 191 (43.3) | 2799 (39.6) | |
| Charleston Comorbidity Index: median (IQR) | 2 (2 – 2) | 2 (2 – 2) | <0.001 |
| Uses Smoking Tobacco: n (%) | 77 (17.0) | 1310 (18.4) | 0.5 |
| Drinks Alcohol: n (%) | 43 (9.5) | 323 (4.5) | <0.001 |
| Illicit Drug Use: n (%) | 38 (8.4) | 321 (4.5) | <0.001 |
| Burn Mechanism: n (%) | <0.001 | ||
| Flame | 348 (76.0) | 2496 (34.7) | |
| Scald | 99 (21.6) | 3530 (49.1) | |
| Other | 11 (2.4) | 1160 (16.1) | |
| Total Body Surface Area Burn: median (IQR) | 29.3 (23.0 – 44.0) | 3 (1.0 – 6.0) | <0.001 |
| Inhalation Injury: n (%) | 142 (31.5) | 357 (5.0) | <0.001 |
| Ventilated: n (%) | 233 (57.1) | 421 (5.9) | <0.001 |
| Intensive Care Unit Length of Stay (days): median (IQR) | 11 (2 – 48) | 0 (0 – 0) | <0.001 |
| Hospital Length of Stay (days): median (IQR) | 27 (7 – 61) | 5 (2 – 10) | <0.001 |
| Death: n (%) | 145 (31.7) | 105 (1.5) | <0.001 |
| TBSA Burns |
Figure 3:
Absolute Mortality by National Area Deprivation Index Quartiles
In the Poisson multivariate regression to determine if the ADI associated with a ≥20% TBSA burn, patients in the highest ADI quartile had an increased relative risk when compared to patients in the second-lowest ADI quartile (RR 1.31, 95% CI 1.02 – 1.68) after controlling for patient age, burn mechanism, illicit drug use, and use of smoking tobacco, Table 3.
Table 3:
Poisson Multivariable Regression identifying risk factors associated with ≥20% TBSA Burn
| Risk Ratio | 95% Confidence Interval | p-value | |
|---|---|---|---|
| Age (years) | 1.01 | 1.00 - 1.01 | <0.001 |
| Area Deprivation Index Quartiles | |||
| 0-24% | 1.02 | 0.65 – 1.59 | 0.9 |
| 25-49% | Ref | - | - |
| 50-74% | 1.23 | 0.94 – 1.59 | 0.1 |
| 75-100% | 1.31 | 1.02 – 1.68 | 0.04 |
| Burn Mechanism | |||
| Flame Burn | 3.86 | 3.09 – 4.84 | <0.001 |
| Scald Burn | Ref | - | - |
| Other | 0.37 | 0.20 – 0.68 | 0.001 |
| Illicit Drug Use | 1.64 | 1.19 – 2.25 | 0.003 |
| Uses Smoking Tobacco | 0.60 | 0.47 – 0.76 | <0.001 |
Of the overall cohort, 6.4% (n = 506) had inhalation injury. There was a male predominance in both the inhalation and no inhalation injury cohort. Patients with inhalation injury were older (45.5 years, SD 22.0 vs. 29.6 years, SD 23.8, p<0.001), were more likely to drink alcohol (n=53,10.7% vs. n=315, 4.3%, p<0.001), and used illicit drugs (n=52,10.5% vs. n=313, 4.3%, p<0.001). In both cohorts, patients were primarily in the National 50 – 74% and 75 – 100% ADI quartiles, with a higher proportion of inhalation injury patients in the highest ADI quartiles, Table 4.
Table 4:
Demographics and Patient Characteristics in Patients in the Presence and Absence of Inhalation Injury
| Inhalation Injury (n=506, 6.4%) |
No Inhalation Injury (n=7360, 93.6%) |
p-value | |
|---|---|---|---|
| Male Sex: n (%) | 310 (61.3) | 4588 (62.4) | 0.7 |
| Age: μ (SD) | 45.5 (22.0) | 29.6 (23.8) | <0.001 |
| Race: n (%) | 0.002 | ||
| White | 273 (54.3) | 3416 (46.8) | |
| Black | 154 (30.6) | 2435 (33.3) | |
| Other Minority | 76 (15.1) | 1455 (19.9) | |
| Population Classification: n (%) | 0.4 | ||
| Rural | 383 (77.9) | 5510 (76.2) | |
| Urban | 109 (22.2) | 1726 (23.9) | |
| National Area Deprivation Index Quartiles: n (%) | 0.02 | ||
| 0-24% | 22 (4.5) | 501 (7.0) | |
| 25-49% | 93 (19.0) | 1614 (22.4) | |
| 50-74% | 158 (32.2) | 2260 (31.4) | |
| 75-100% | 217 (44.3) | 2826 (39.2) | |
| Charleston Comorbidity | 2 (2 – 2) | 2 (2 – 2) | <0.001 |
| Index: median (IQR) | |||
| Uses Smoking Tobacco: n (%) | 98 (19.8) | 1328 (18.3) | 0.4 |
| Drinks Alcohol: n (%) | 53 (10.7) | 315 (4.3) | <0.001 |
| Illicit Drug Use: n (%) | 52 (10.5) | 313 (4.3) | <0.001 |
| Burn Mechanism: n (%) | <0.001 | ||
| Flame | 476 (94.8) | 2433 (33.2) | |
| Scald | 5 (1.0) | 3696 (50.4) | |
| Other | 21 (4.2) | 1199 (16.4) | |
| Total Body Surface Area | 5.0 (0.0 – 23.5) | 3.0 (1.0 – 7.0) | 0.009 |
| Burn: median (IQR) | |||
| Ventilated: n (%) | 336 (77.4) | 325 (4.5) | <0.001 |
| Intensive Care Unit Length of Stay (days): median (IQR) | 11 (2 – 34) | 0 (0 – 0) | <0.001 |
| Hospital Length of Stay (days): median (IQR) | 14 (3 – 44) | 5 (2 – 11) | <0.001 |
| Death: n (%) | 125 (24.7) | 130 (1.8) | <0.001 |
In the Poisson multivariate regression to determine if the national ADI is associated with an inhalation, patients in the highest ADI quartile had an increased relative risk when compared to patients in the second-lowest ADI quartile (RR 1.39, 95% CI 1.09 – 1.76) when controlled for patient age, race, illicit drug use, alcohol use, and use of smoking tobacco, Table 5.
Table 5:
Poisson Multivariable Regression identifying risk factors associated with Inhalation Injury
| Risk Ratio | 95% Confidence Interval | p-value | |
|---|---|---|---|
| Age (years) | 1.03 | 1.02 – 1.03 | <0.001 |
| Area Deprivation Index Quartiles | |||
| 0-24% | 0.78 | 0.49 – 1.24 | 0.3 |
| 25-49% | Ref | - | - |
| 50-74% | 1.26 | 0.98 – 1.63 | 0.07 |
| 75-100% | 1.39 | 1.09 – 1.76 | 0.008 |
| Race | |||
| White | Ref | - | - |
| Black | 0.82 | 0.68 – 1.00 | 0.05 |
| Other Minority | 0.92 | 0.71 – 1.18 | 0.5 |
| Uses Smoking Tobacco | 0.68 | 0.54 – 0.86 | 0.001 |
| Alcohol Use | 1.65 | 1.23 – 2.20 | 0.001 |
| Illicit Drug Use | 2.33 | 1.73 – 3.14 | <0.001 |
Of the overall cohort, 118 patients (1.5%) were admitted >1 time for burn injuries and included in the database. Of those, 4 (3.4%), 32 (27.1%), 33 (28.0%), and 49 (41.5%) patients were in the least to most disadvantaged ADI quartiles.
Discussion
Residential fires account for the majority of burn injuries, hospitalizations, and fatalities. At our regional burn center, we found a 31% increased relative risk of ≥20% TBSA burns, among patients who reside in the highest ADI quartile. We also demonstrate a 39% increased relative risk of inhalation injury in those who live in the highest ADI quartile. We could not show any direct correlation between mortality and residing in a high ADI neighborhood. Our finding that residential burn injury results in higher severity burn and a higher likelihood of inhalation injury are the two main drivers of burn mortality. It, therefore, stands to reason that residential neighborhood has a strong correlation with burn mortality outcome.
Previous analysis of the role of socioeconomic status on burn injury and outcome have utilized a single variable as a measure representing a geographic area or neighborhood such as educational and occupational composition, household income and employment status, or housing conditions to classify communities. [23] The advantage of the ADI rests in its composite index consisting of several key indicators drawn from these domains that would more accurately reflect the multidimensional characterization of a community’s socioeconomic position.[24–25]
North Carolina’s median national ADI rank is 61 (IQR 42 – 79). Therefore, North Carolina has a higher proportion of more disadvantaged neighborhoods than the United States (50, IQR 25 – 75) at large and from our results likely contribute to the increased number of burn injuries seen in North Carolina.[20] The higher ADI seen in North Carolina is due to the nearly quarter of all North Carolinians living in rural regions, who have a higher poverty rate (18.3% vs. 12.9%) and higher high school dropout rate (17.1% vs. 11.4%) than their urban counterparts.[26]
Globally, burns are a problem of low- and middle-income countries, with 70% of all burns occurring in those regions.[27] Globally, burn risk correlates with socioeconomic status.[28] Several previous studies have demonstrated in the US that low socioeconomic status and poverty play a role in the risk of injury and death following a residential fire.[29],[30] This may be attributable to low smoke detector use, living in mobile or substandard homes, living in older homes, and using alternative heating methods, such as space heaters.[31],[32],[33]
In 1973, the landmark report of the US National Commission on Fire Prevention and Control, American Burning, was published.[34] In response to this report, the Federal Fire Prevention and Control Act of 1974 was passed, leading to the formation of several organizations, including the United States Fire Administration.[35] Since that time, numerous interventions, including the enforcement of fire safety building codes and fire prevention education, have been put into practice.[36] Fire prevention using automatic fire sprinklers and smoke alarms can save lives, reduce injuries, lessen property damage, and avoid environmental toxins due to smoke. [37]
The strength of our findings is in the utilization of ADI for burn prevention initiatives. Burn injury prevention strategies should target high risk, high ADI neighborhoods to reduce the risk of severe burn injuries. These strategies should include focusing federal funding to fire sprinkler installment in public housing and apartment buildings in high ADI regions, as North Carolina only mandates sprinkler systems in apartments up to and including 4 stories in height built after 2006. [38] In addition, prioritizing burn injury intervention in schools located in high ADI communities, as there is no statewide mandatory school education. [39] Beyond neighborhood characteristics, it is also essential to better understand individual behaviors that may lead to a higher risk of residential burns. Both individual, neighborhood, and community-level intervention may provide a new possible avenue for better-targeted prevention strategies. In this study, similar to other studies, we show the increased risk of higher severity burns and inhalation injury in patients that tested positive for alcohol and other illicit drugs.[40]
This research was limited to patients admitted to a single burn center. It does not include patients admitted to different hospitals with burn injuries and those not hospitalized. Though our burn center draws from a catchment population of over two-thirds of the state, our cohort does not represent all fire incidents across North Carolina over the study period. Specific housing characteristics of each burn patient and the level of fire protection is unknown. This study is also restricted by the inherent limitations of its retrospective design. The missing data in ADI was not missing at random. Patients without ADI had slightly higher %TBSA (median 4%, IQR 2 – 10) and inhalation injury (n = 16, 10.1%). As patients who do not have recorded home addresses and suppressed ADI national rankings are more likely not to have fixed addresses, to live in high-density housing, and in very rural regions, they are more likely to live in highly disadvantaged situations compared to the general population in this study. However, by missing these data, we are more likely to underestimate the importance of ADI on residential burns, and therefore bias towards the null.
Conclusion
Residential fires remain the primary source of burn injuries in the United States. People who reside in the highest ADI quartile are more like to present with higher burn injury severity in terms of burn size and the presence of inhalation injury. The use of the ADI to target neighborhoods for burn prevention is imperative. This study provides insights into the consequences of fires based on the residential address.
Highights.
Residential structures have been the source of the majority of fire-related injuries and deaths.
Traditional poverty markers, such as median household income and federal poverty line, do not truly capture the essence of a residential neighborhood or a patient’s socioeconomic status.
There is an increased burn injury severity in patients who reside in neighborhoods with a high Area Deprivation Index (ADI).
Patients in the highest ADI quartile had an increased relative risk of presenting with worse burns as defined by burn size (RR 1.31) and inhalation injury (RR 1.39).
Acknowledgments
This work was supported by the National Institute of Health under award number: 5T32GM008450-23 (Coleen Bartley) and #D43TW009340 ( Laura Purcell)
Footnotes
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