Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa, United States.
Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, United States.
Burns. 2021 Aug;47(5):1177-1182. doi: 10.1016/j.burns.2020.10.025. Epub 2020 Nov 10.
Race and socioeconomic status influence outcomes for adult and pediatric burn patients, yet the impact of these factors on elderly patients (Medicare eligible, 65 years of age) remains unknown.
Data pooled from three verified burn centers from 2004 to 2014 were reviewed retrospectively. Age, race, gender, percent total body surface area (%TBSA) burn, mortality, length of stay (LOS), LOS per %TBSA burn, and zip code which provided Census data on race, poverty, and education levels within a community were collected. Data were analyzed using logistic and generalized linear models in SAS version 9.4 (SAS Institute, Cary, NC, USA).
Our population was mainly Caucasian (63%), African American (18%), Hispanic (7.6%), and Asian (3.5%). Mean age was 76.3 ± 8.3 years, 52.5% were male. Mean %TBSA was 9 ± 13.8%; 15% of the patients sustained an inhalation injury. The mortality rate was 14.4%. Inhalation injury was significantly associated with mortality and discharge to a skilled nursing facility (SNF) (p < 0.05). Race was significantly associated with socioeconomic disparities and affected LOS/TBSA, but not discharge to SNF or mortality on univariate analysis. Poverty level, education level, and insurance status (others vs. public) independently predicted SNF discharge, while median income and insurance type independently predicted LOS/TBSA.
In this elderly cohort, race did not predict standard markers of burn outcome (mortality and discharge to SNF). Socioeconomic status independently predicted LOS and discharge to SNF, suggesting a relationship between socioeconomic status and recovery from a burn injury. Better understanding of racial and socioeconomic disparities is necessary to provide equitable treatment of all patients.
种族和社会经济地位会影响成人和儿科烧伤患者的结局，但这些因素对老年患者（有医疗保险资格，65 岁以上）的影响尚不清楚。
回顾性分析了 2004 年至 2014 年来自三个经过验证的烧伤中心的数据。收集了年龄、种族、性别、总体表烧伤百分比（%TBSA）、死亡率、住院时间（LOS）、每%TBSA 烧伤的 LOS 以及邮政编码，这些邮政编码提供了社区内种族、贫困和教育水平的人口普查数据。使用 SAS 版本 9.4（SAS Institute，Cary，NC，USA）中的逻辑和广义线性模型分析数据。
我们的人群主要是白种人（63%）、非裔美国人（18%）、西班牙裔（7.6%）和亚洲人（3.5%）。平均年龄为 76.3 ± 8.3 岁，52.5%为男性。平均%TBSA 为 9 ± 13.8%；15%的患者发生吸入性损伤。死亡率为 14.4%。吸入性损伤与死亡率和转至康复医院（SNF）显著相关（p < 0.05）。种族与社会经济差异显著相关，并影响 LOS/TBSA，但在单变量分析中与 SNF 转归或死亡率无关。贫困水平、教育水平和保险状况（其他与公共）独立预测 SNF 出院，而中位数收入和保险类型独立预测 LOS/TBSA。
在这个老年患者队列中，种族并未预测烧伤结局的标准标志物（死亡率和转至 SNF）。社会经济地位独立预测 LOS 和 SNF 出院，表明社会经济地位与烧伤康复之间存在关系。更好地了解种族和社会经济差异对于为所有患者提供公平治疗至关重要。
