Community-Level Disparities in the Inhalation Injury Patient Population

Low-income neighborhoods face higher fire risk due to overcrowding, substandard housing, and limited access to safety devices, contributing to greater burn severity among affected residents. Inhalation injury, a frequent consequence, often necessitates early intubation and transfer to burn centers. Given the high degree of coordination required, this study examines how management strategies and outcomes vary across levels of social vulnerability and urbanicity, 2 community-level proxies for access to care. We retrospectively reviewed inhalation injuries diagnosed by bronchoscopy at a single ABA-certified burn center (2012-2024), limited to structure fires. Community vulnerability was estimated using the Social Vulnerability Index (SVI; low <0.5, moderate 0.5-0.74, and high ≥0.75) and urbanicity using Rural-Urban Commuting Area (RUCA) codes (<4 = urban). Clinical outcomes were compared across SVI and RUCA groups using univariate and multivariate analyses. Among 184 patients, higher social vulnerability was associated with a greater proportion of Black individuals and higher asthma prevalence. Clinical characteristics, burn severity, timing of intubation, intensive care unit/hospital length of stay, ventilator days, and surgical interventions did not differ significantly across SVI or rural-urban groups. Transfer from outside hospitals was more common among rural residents (51.4% vs 30.1%), who were also more likely to be intubated at the scene (35% vs 30%). In multivariable analyses, high social vulnerability independently predicted increased mortality risk, although it was not associated with pneumonia, acute respiratory distress syndrome, or ventilator duration. Most patients with inhalation injuries come from socially vulnerable communities, yet higher SVI did not convincingly affect clinical outcomes, suggesting equitable acute care delivery when resources are available.