Durham Devon, Rennie Christopher, Reindel Kelsey
Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Osteopathic Principles and Practice, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Cureus. 2024 Mar 27;16(3):e57035. doi: 10.7759/cureus.57035. eCollection 2024 Mar.
Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.
引言
烧伤是全球范围内创伤的主要机制,由摩擦、寒冷、热、辐射、化学或电等因素引起。最常见的是,烧伤是由于接触热液体、固体或火焰导致的,分别称为烫伤和火焰烧伤。这类损伤很复杂,会带来重大的受伤和死亡风险,尤其是在儿童群体中。烧伤创伤预防一直是美国的一个主要关注点,有增加公共卫生宣传和安全措施的举措。不幸的是,社会经济处境不利的儿童面临这类损伤的比例可能过高,我们旨在突出佛罗里达社区内存在的这些差异(如果有的话)。
材料与方法
本研究设计为一项回顾性观察分析,使用来自佛罗里达健康社区健康评估资源工具集(CHARTS)的公开数据。提取了2018 - 2020年导致急诊就诊的非致命烧伤损伤数据。这些数据仅限于0至19岁的人群,并转换为每10万人的烧伤损伤率。每个县的社会人口统计学细节从县健康排名与路线图中记录下来,并与各相应县的烧伤数据进行比较。对分类数据生成频率,并使用泊松分布的广义线性模型和双变量相关性对烧伤率和社会人口统计学细节进行统计分析,p < 0.05。
结果
在佛罗里达州,每10万人的年烧伤率中位数为136(四分位距:96 - 179),杰克逊县的烧伤率最高,为323,而格莱兹、哈迪和拉斐特县的烧伤率均为0。在所检查的18个社会经济因素中,共有5个因素对非致命烧伤损伤急诊就诊没有统计学上的显著影响:严重住房问题、亚洲人百分比、青少年生育率、贫困儿童(<18岁)百分比以及严重住房成本负担。在儿科患者非致命烧伤急诊就诊中发现的两个最重要因素是19岁以下无医疗保险者的百分比和三年级学生阅读成绩的平均年级水平表现。当使用弗思偏差调整估计和过度分散对小样本量进行调整时,阅读成绩和无保险者在儿科烧伤损伤中都起着重要作用。阅读成绩每提高一分,发病率比值下降97.1%(95%置信区间)。儿童参保率每增加一个百分点,儿科烧伤损伤减少28.8%(95%置信区间)。
结论
该分析突出了佛罗里达州所有67个县在多个健康社会决定因素(SDOH)方面儿科烧伤率的增加。这里的研究结果表明,社会人口统计学较低和较高地区之间的烧伤率可能继续存在不成比例的分布。本研究进一步突出了佛罗里达社区内的这一趋势,并且需要持续研究以满足社会人口统计学较低地区的需求,从而改善弱势群体(如儿童)的烧伤率,这些儿童受伤风险增加。