Primary Care Attachment and Long-Term Mortality in Burn Survivors: A Population-Based Cohort Study

Burn survivors are at greater risk of mortality due to cancer and chronic disease than the general population, which may be preventable with regular primary care. This study aimed to determine the association between primary care provider (PCP) attachment and long-term mortality in burn survivors. We conducted a retrospective population-based cohort study including all adults in Ontario who survived hospitalization for a major burn injury between 2010 and 2022. Primary care provider attachment (as a marker of regular primary care) was categorized as attached or uncertainly attached. The primary outcome was 5-year all-cause mortality, with follow-up until death or March 31, 2023. Kaplan-Meier curves were used to estimate cumulative mortality. Cox proportional hazards (CPH) models assessed the association between PCP attachment and mortality after adjusting for age, sex, comorbidity, rurality, immigration status, and socioeconomic characteristics. Among 1968 burn survivors (median age 47 years, 73% male), 86% were attached to a PCP. Primary care provider-attached individuals had a greater burden of medical comorbidities but similar burn injury severity. Five-year mortality was 11% in PCP-attached and 9% in uncertainly attached burn survivors. Time-stratified CPH models did not demonstrate a significant association between PCP attachment and mortality postdischarge either within (hazard ratio [HR]: 0.77; 95% CI, 0.41, 1.43) or beyond 2 years (HR: 0.77; 95% CI, 0.38, 1.57) after discharge. Primary care provider attachment was common among burn survivors, though not significantly associated with long-term survival. Attachment to primary care, in isolation, may not represent meaningful or regular primary care use that would reduce the chronic disease burden in burn survivors.