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Community-level Disparities In The Inhalation Injury Patient Population
Christopher J. Fedor, MS; Hilary Y. Liu, BS; Jose A. Arellano, MD; Mare G. Kaulakis, BS; Garth A. Elias, MD; Alain C. Corcos, MD; Matthew P. Siedsma, MD; Jenny A. Ziembicki, MD; Francesco M. Egro, MD, MSc, MRCS
University of Pittsburgh, School of Medicine
2025-01-02
Presenter: Christopher J. Fedor
Affidavit:
I agree.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE:
Socioeconomic status is linked to the incidence and severity of burns and inhalation injuries from house fires. Lower-income neighborhoods face higher residential fire rates due to overcrowding, poor housing conditions, and lack of fire safety devices. Inhalation injuries can be life-threatening, and social or structural barriers may worsen socioeconomic and racial disparities. This study analyzes trends in management, outcomes, and disparities among patients with inhalation injuries.
METHODS:
We retrospectively reviewed inhalation injuries diagnosed via fiberoptic bronchoscopy in patients from structure fires at a single ABA-certified burn center (January 2012-January 2024). Patient zip codes were matched with US Census data to estimate urbanicity (RUCA codes) and social vulnerability index (SVI). Patients were categorized into three SVI groups: low (<0.5), high (≥0.5 and <0.75), or very high (≥0.75). Multivariate regression analyses adjusted for age and total body surface area (TBSA) of burns.
RESULTS:
The study included 184 confirmed inhalation injury cases. The majority (91.7%) were White. 79.9% were from urban communities (RUCA<4). SVI distribution was 19.6% low, 27.7% high, and 52.7% very high. Black patients were more likely to live in high SVI neighborhoods (p=0.006). Regression analyses showed no significant differences in ventilator days, hospital length of stay, or excision and graft rates; TBSA was the only significant predictor of increased ventilator and hospital days (p<0.001).
CONCLUSIONS:
Patients suffering inhalation injuries predominantly live in socially vulnerable, urban communities. However, residence in a more vulnerable area was not predictive of worse clinical outcomes, suggesting equitable treatment is possible when resources are available.
