Unequal healing: Racial differences in hypertrophic scarring following burn injuries

Hypertrophic scarring is a common complication of burn injuries, and its incidence and treatment outcomes vary among racial groups. The motivation for this study was to further understand the disparities in hypertrophic scar formation that exist amongst different racial groups. This study aimed to address the gaps by investigating disparities in hypertrophic scar formation among African American, Asian, and White patients one year after burn injury.

We conducted a retrospective cohort study using the TriNetX Research Network, a federated database of de-identified electronic health records from over 116 million patients across 112 healthcare organizations (HCOs) as of August 28, 2024. Patients were stratified by race. Propensity score matching adjusted for age, gender, and burn severity. Hypertrophic scarring was assessed at one, six, and twelve months. Relative risk ratio was calculated using White patients as the reference cohort. Statistical significance was deemed p < 0.05.

We identified 633,708 adult burn patients (≥18 years) treated between 2013 and 2023. African American, Asian, and Native Hawaiian patients had significantly higher risks of hypertrophic scarring compared to White patients (p < 0.05). At six months and one-year, similar trends persisted across racial groups. Among the 46,893 patients with hypertrophic scarring, 63.06 % were White, 13.50 % Black, 2.47 % Asian, 0.55 % Native Hawaiian, and 0.54 % American Indian. Interestingly, Native Hawaiians demonstrated a decreased risk in specific subgroup analyses (p < 0.05).

Significant racial disparities exist in hypertrophic scarring incidence following burn injury. African American, Asian, and Native Hawaiian patients are at elevated risk compared to White patients. Further research is needed to develop equitable prevention and treatment strategies for high-risk patient populations.