Residential Air Pollution, Inhalation Injury, and Burn Recovery: A Burn Model System Study

Chronic air pollution, specifically particulate matter 2.5 (PM2.5), increases the risk and severity of acute respiratory distress syndrome, and is most concentrated in lower-income areas. Burn survivors from these communities may be especially vulnerable to respiratory complications of burn injury and inhalation injuries. In this retrospective national longitudinal cohort study of adult burn survivors (2015 and 2021), the association of 3-year pre-burn PM2.5 exposure, estimated from home census tract code from the CDC, and clinical outcomes extracted from the Burn Model System (mortality, ventilator days, tracheostomy, hospital length of stay (LOS), and patient-reported outcomes from PROMIS Global Health and employment status at 6 and 12 months) were assessed via mixed-effects regression models adjusting for age, sex, race/ethnicity, total body surface area (TBSA), and inhalation injury. Among 582 adult burn survivors (mean age of 46.2 years), unadjusted models found that higher PM2.5 exposure was associated with longer LOS, worse PROMIS Global Health scores (pooled 6- and 12-months), and a decreased likelihood of employment at follow-up (pooled 6- and 12-months). These associations were attenuated after adjustment; though PM2.5 exposure was associated with inhalation injury, which was strongly associated with prolonged ventilation, tracheostomy, lower Global Health scores, and lower employment at follow-up. Higher PM2.5 exposure was associated with a greater likelihood of inhalation injury, which was associated with poorer outcomes, suggesting that residential PM2.5 exposure, or factors that co-vary with it, may identify patients at greater risk for inhalation injury and poorer recovery after burn injury.