Hong Philip Kyung Woo, Santana Juan Pablo, Larson Shawn D, Berger Amy M, Indelicato Lauren A, Taylor Janice A, Mustafa Moiz M, Islam Saleem, Neal Dan, Petroze Robin T
Department of Surgery, University of Florida, Gainesville, FL.
College of Medicine, University of Florida, Gainesville, FL.
Surgery. 2022 Nov;172(5):1510-1515. doi: 10.1016/j.surg.2022.06.039. Epub 2022 Aug 26.
Burn injury risk, severity, and outcomes have been associated with socioeconomic status. Limited data exist to evaluate health access-related influences at a structural population level. This study evaluated factors at the Census-tract level, specifically evaluating food access and social vulnerability in pediatric scald burns.
A single-institution retrospective review using the trauma registry and electronic medical record was conducted of pediatric burns between 2016 and 2020. Home address was coded to the Census-tract level and bulk analyzed. Socioeconomic metrics of the home environment were evaluated from publicly available databases, the United States Food and Drug Administration Food Access Research Atlas, and the Centers for Disease Control's Social Vulnerability Index.
There were 840 patients that met inclusion criteria (49.8% scald, N = 418). The mean total body surface area for scalds was 6.6% with an age of 10.2 years; 76% (n = 317) of scalds had Medicaid, and 15% (n = 63) were due to hot noodles. Scalds occurred more in females (45.7%, N = 191 vs 28.0%, N = 118; P < .0001), non-White race (62.7%, N = 262 vs 29.1%, N = 123; P < .0001), and low-income and low-food access populations (39.8%, N = 147 vs 30.4%, N = 116; P = .007). Low-food access Black populations showed increased scald injury (18% [interquartile range 6-35] vs 10% [interquartile range 4-25]), whereas all other populations showed no association. The patients with scalds had a higher overall social vulnerability index (0.67 vs 0.62, P = .008).
Often related to poverty, health access, and health equity, population-level social determinants of health like social vulnerability and food access have significant impact on health care and should influence health outreach and systems improvement.
烧伤的风险、严重程度和预后与社会经济地位相关。在结构性人群层面，评估与医疗服务可及性相关影响的数据有限。本研究在人口普查区层面评估相关因素，特别评估小儿烫伤中的食物可及性和社会脆弱性。
利用创伤登记系统和电子病历对2016年至2020年期间的小儿烧伤患者进行单机构回顾性研究。将家庭住址编码到人口普查区层面并进行整体分析。从公开可用数据库、美国食品药品监督管理局食品可及性研究地图集以及疾病控制中心的社会脆弱性指数中评估家庭环境的社会经济指标。
有840名患者符合纳入标准（49.8%为烫伤，N = 418）。烫伤患者的平均烧伤总面积为6.6%，年龄为10.2岁；76%（n = 317）的烫伤患者有医疗补助，15%（n = 63）的烫伤是由热面条导致。女性（45.7%，N = 191 对比 28.0%，N = 118；P <.0001）、非白人种族（62.7%，N = 262 对比 29.1%，N = 123；P <.0001）以及低收入和食物可及性差的人群（39.8%，N = 147 对比 30.4%，N = 116；P =.007）发生烫伤的情况更多。食物可及性差的黑人人群烫伤发生率更高（18%[四分位间距6 - 35]对比10%[四分位间距4 - 25]），而其他所有人群均未显示出相关性。烫伤患者的总体社会脆弱性指数更高（0.67对比0.62，P =.008）。
社会脆弱性和食物可及性等与贫困、医疗服务可及性和健康公平性相关的人群层面健康的社会决定因素，对医疗保健有重大影响，应影响健康推广和系统改善。
