P. Hong3, J. P. Santana3, S. D. Larson1, A. M. Berger4, L. A. Indelicato1, J. A. Taylor1, M. M. Mustafa1, S. Islam1, D. Neal2, R. T. Petroze1 1University Of Florida, Division Of Pediatric Surgery, Gainesville, FL, USA 2University Of Florida, Department Of Surgery, Gainesville, FL, USA 3University Of Florida, College Of Medicine, Gainesville, FL, USA 4University Of Florida, Shands Children’s Hospital, Gainesville, FL, USA
Introduction: Burns present significant morbidity within the pediatric population, and burn injury risk, severity, and outcome have been associated with socioeconomic status. Studies often evaluate social determinants of health through data available in the medical record or administrative databases, including race, gender, and insurance status. However, limited data exists to evaluate poverty and health access-related influences at a structural population level. This study evaluates the role of structural factors related to poverty, food access, and public benefit utilization at the census tract level, specifically evaluating food deserts and social vulnerability in pediatric scald burns.
Methods: A single-institution retrospective review was conducted of pediatric burns (<16 years old) identified in the trauma registry between January 2016 and December 2020. First degree burns were excluded. Patient demographics, burn injury mechanism, burn characteristics, operative details, outcomes, complications and outpatient follow-up were abstracted from the trauma registry and electronic medical record. Patient address was used to obtain geocodes at the census tract level using publicly-available resources through the US Census Bureau. Socioeconomic metrics of the home environment, including poverty rate, food access, urban/rural designation, public benefits received, and low-income or low-access tract were estimated at the census tract level from the Food Access Research Atlas and the social vulnerability index (relative vulnerability of a US census tract to a hazardous event as defined by the CDC). Descriptive statistics were used to describe demographic patterns and outcomes were evaluated using univariate analysis comparing scald to non-scald.
Results: 840 patients met inclusion criteria (49.8% scald, N=418, 50.2% no scald, N=422). Mean TBSA for scald was 6.6% with an age of 10.2 years. 76% (n=317) of scald had Medicaid and 15% (n=63) were due to hot noodles with the remainder due to hot liquid. Scald occurred more in females (45.7%, N=191 vs 28.0%, N=118; p<0.0001), non-white race (62.7%, N=262 vs 29.1%, N=123; p<0.0001) and low-income and low-food access populations (39.8 %, N=147 vs 30.4%, N=116; p=0.007). Low-access black populations showed increased scald injury (18% [IQR 6-35] vs 10% [IQR 4-25]) while all other populations showed no association. Patients with scald had a higher overall social vulnerability index (0.67 vs 0.62, p=0.008) with the category of minority status and language having the highest significance (0.42 vs 0.32, p<0.0001). Report of physical abuse was higher in patients with scald than no scald (10.8%, N=45 vs 6.6%, N=28; p=0.037).
Conclusion: Often related to poverty, health access and health equity, population-level social determinants of health like food access and social vulnerability have significant impact on patient outcomes and should influence health outreach, systems improvement, and prevention measures.