Sex dimorphism in pediatric burn mortality in Malawi: A propensity matched analysis

There is increasing evidence that sex differences may influence pathophysiology after thermal injury and affect clinical outcomes. This study aimed to assess the relationships between sex, thermal injury, and inpatient mortality in a pediatric burn cohort in a resource-limited setting.

This is a retrospective analysis of data collected from the Kamuzu Central Hospital Burns Unit, in Lilongwe, Malawi, from May 2011 to December 2019 on all pediatric patients (≤12 years). We performed a bivariate analysis by sex comparing demographics, burn characteristics, surgical intervention, and mortality. Standardized estimates were adjusted using the inverse probability of treatment weights to account for confounding. Following weighting, odds of mortality based on sex were obtained via logistic regression modeling.

A total of 1904 children were admitted with a male preponderance (n = 1065, 55.9 %). Overall, the median age was 3 years (IQR1-4). Females had a higher percent total body surface area (%TBSA) burn than males, 15 % vs. 13 % (p = 0.03), respectively. Flame burns were more frequent in females compared to males, 32 % and 23 %, respectively (p < 0.001). There were higher rates of surgical intervention in females than males (20.9 % vs. 16.7 %, p = 0.02). The propensity score weighted logistic regression predicting mortality revealed no difference in the odds of mortality based on sex (OR 1.12, 95 % CI 0.82-1.52, p = 0.5).

We show males are just as likely to die from burns compared to females with similar injuries in this propensity-matched analysis. A lack of difference in mortality may be attributable to the similarities in the hormonal profile in the prepubescent child.