Impact of Housing on Burn Injury Patterns and Outcomes: A Retrospective Cohort Study at a Canadian Burn Center

Houselessness is an important social determinant of health, which may predispose to poor health and difficulty in recovering from new health issues. We examined the demographic variables and clinical outcomes of housed and unhoused patients experiencing thermal injuries. A retrospective chart review was performed on all patients admitted to or followed by the burn service from January 2022 to June 2024. There were 571 new thermal injuries requiring admission at our institution, including 414 patients with housing and 157 unhoused patients. Frostbite accounted for 35% of admissions among unhoused patients, which was significantly greater than the 10% of housed patient admissions for frostbite injuries (P < .0001), where thermal burns accounted for the majority of injuries requiring admission. Substance use was significantly higher in the unhoused population (P < .0001). Unhoused patients on the burn service were 10-fold more likely to leave against medical advice, compared with housed patients (P < .00001). Interestingly, the mean length of stay was not significantly different between the housed and unhoused inpatients; however, it was significantly different with the exclusion of patients who left against medical advice (18.21 ± 30.84 days vs 24.70 ± 26.30 days; P = .03). The houseless population in Canada experiences unique challenges due to the extreme cold, while their inpatient-care providers are challenged by a resource-constrained system. These results suggest the need for additional support for thermal injury prevention and substance use disorder treatment among the unhoused population.