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Association of race and ethnicity with pediatric burn outcomes: A population study of the Kids' Inpatient Database

Austin L Du¹, Phil Y Yao², Rodney A Gabriel³

¹School of Medicine, University of California, San Diego, La Jolla, CA, USA; Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego, La Jolla, CA, USA.

Burns : Journal of the International Society for Burn Injuries

|September 10, 2023

Insights

Race and ethnicity impact pediatric burn outcomes differently than in adults. While overall morbidity is similar, Hispanic children had longer hospital stays, and Black children experienced longer stays with severe burns.

Area of Science:

Pediatric burn care research
Health disparities in children
Inpatient pediatric outcomes

Background:

Most burn outcome studies focus on adults, leaving pediatric disparities unclear.
Socioeconomic and environmental factors affecting adult burn patients may differ in children.
This study investigates race and ethnicity impacts on pediatric burn patient outcomes.

Purpose of the Study:

To determine if race and ethnicity influence outcomes in pediatric burn patients.
To analyze disparities in morbidity, mortality, disposition, and length of stay.
To explore these disparities within socioeconomic status and burn severity subgroups.

Main Methods:

Utilized the Kids' Inpatient Database (2016, 2019) for US pediatric burn patients.
Primary exposure: race/ethnicity. Primary outcome: composite in-hospital morbidities.
Analyzed secondary outcomes (death, disposition, length of stay) using regression models, isolating subgroups.

Main Results:

Included 12,582 pediatric burn patients.
No significant difference in composite morbidity between White patients and other groups.
Hispanic ethnicity linked to longer length of stay and routine discharge; Black patients had longer stays with severe burns.

Conclusions:

Race/ethnicity-driven outcome disparities seen in adults may not directly apply to pediatric burn patients.
Findings suggest unique factors influence pediatric burn outcomes.
Highlights the need for nuanced approaches to pediatric health equity in burn care.

Read full analysis

Abstract

Background:

While most studies on burn outcomes have focused on adults, it is unclear if the same socioeconomic and environmental inequalities affect paediatric patients. This study aims to investigate the impact of race and ethnicity on outcomes in paediatric burn patients.

Methods:

The Kids' Inpatient Database is released by Agency for Healthcare Research and Quality, and is the largest publicly available database for the United States inpatient paediatric population. All paediatric burned patients in 2016 and 2019 were identified. Race and/or ethnicity was the primary exposure variable, and the primary outcome was a composite of several in-hospital morbidities. Secondary outcomes included death, non-routine disposition, and length of stay. Fine-Gray competing risks regression and multivariable logistic regression were used to analyze length of stay and all other outcomes, respectively. Analysis also isolated subgroups related to socioeconomic status and case severity.

Results:

We included12,582 pediatric burn patients in this study. No difference was found in composite morbidity between White patients and those of other race or ethnicity groups. Hispanic ethnicity was associated with longer lengths of stay and increased odds of routine (i.e. home) discharge. Black patients had increased length of stay compared to White patients only in severe burn cases.

Conclusions:

Our study implies that race- or ethnicity-associated mechanisms driving outcome disparities in adults does not necessarily apply in paediatric burn patients.

Keywords:

Burns Cultural competence Healthcare disparities Length of stay Pediatrics

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