Ross Tilley Burn Center, Canada.
Burn Model System National Data and Statistical Center, USA.
Burns. 2023 Jun;49(4):861-869. doi: 10.1016/j.burns.2022.06.004. Epub 2022 Jun 23.
Individual-level socioeconomic disparities impact burn-related incidence, severity and outcomes. However, the impact of community-level socioeconomic disparities on recovery after burn injury is poorly understood. As a result, we are not yet able to develop individual- and community-specific strategies to optimize recovery. Therefore, we aimed to characterize the association between community-level socioeconomic disparities and long-term, health-related quality of life after burn injury.
We queried the Burn Model System National Longitudinal Database for participants who were> 14 years with a zip code and who had completed a health-related quality of life (HRQOL) questionnaire (VR-12) 6 months after injury. BMS data were deterministically linked by zip code to the Distressed Communities Index (DCI), which combines seven census-derived metrics into a single indicator of economic well-being, education, housing and opportunity at the zip code level. Hierarchical linear models were used to estimate the association between community deprivation and HRQOL 6 months after burn injury, as measured by mental (MCS) and physical (PCS) component summary scores of the SF12/VR12.
342 participants met inclusion criteria. Participants were mostly male (n = 239, 69 %) and had a median age of 48 years (IQR 33-57 years). Median %TBSA was 10 (IQR 3-28). More than one-third of participants (n = 117, 34 %) lived in a community within the highest two distress quintiles. After adjusting for age, race/ethnicity, number of trips to the operating room (OR) and pre-injury PCS, neighbourhood distress was negatively associated with 6-month PCS (ß-0.05, 95 % CI [-0.09,-0.01]). Increasing age and lower pre-injury PCS were also negatively associated with 6-month PCS. There was no observed association between neighbourhood distress and 6-month MCS after adjustment for age, participant race/ethnicity, number of trips to the OR and pre-injury MCS. Higher pre-injury MCS was associated with 6-month MCS (ß0.54, 95 % CI [-0.41,0.67]).
Community distress is associated with lower PCS at 6 months after burn injury but no association with MCS was identified. Pre-injury HRQOL is associated with both PCS and MCS after injury. Further study of the factors underlying the relationship between community distress and physical functional recovery (e.g., access to rehabilitation services, availability of adaptations) is required to identify potential interventions.
个体层面的社会经济差异会影响烧伤的发生率、严重程度和结局。然而，社区层面的社会经济差异对烧伤后康复的影响尚不清楚。因此，我们还不能制定针对个体和社区的策略来优化康复效果。因此，我们旨在描述社区层面的社会经济差异与烧伤后长期健康相关生活质量之间的关系。
我们通过烧伤模型系统国家纵向数据库查询了 14 岁以上有邮政编码且在受伤后 6 个月完成健康相关生活质量（HRQOL）问卷（VR-12）的参与者。BMS 数据通过邮政编码与贫困社区指数（DCI）进行确定性链接，该指数将七种人口普查衍生指标结合起来，成为邮政编码层面经济福利、教育、住房和机会的单一指标。使用分层线性模型来估计社区贫困与烧伤后 6 个月 HRQOL 之间的关系，由 SF12/VR12 的心理（MCS）和身体（PCS）分量综合评分来衡量。
342 名参与者符合纳入标准。参与者主要为男性（n=239，69%），中位年龄为 48 岁（IQR 33-57 岁）。中位%TBSA 为 10（IQR 3-28）。超过三分之一的参与者（n=117，34%）居住在最高两个压力五分位数的社区中。在调整年龄、种族/民族、手术次数和受伤前 PCS 后，邻里贫困与 6 个月 PCS 呈负相关（β-0.05，95%CI [-0.09，-0.01]）。年龄增加和受伤前 PCS 较低也与 6 个月 PCS 呈负相关。在调整年龄、参与者种族/民族、手术次数和受伤前 MCS 后，邻里贫困与 6 个月 MCS 之间没有观察到关联。较高的受伤前 MCS 与 6 个月 MCS 相关（β0.54，95%CI [-0.41，0.67]）。
社区压力与烧伤后 6 个月时的 PCS 较低相关，但与 MCS 无关。受伤前的 HRQOL 与受伤后的 PCS 和 MCS 都相关。需要进一步研究社区压力与身体功能恢复之间关系的潜在因素（例如，康复服务的可及性、适应性的可用性），以确定潜在的干预措施。
