Geographic Accessibility of Burn Centers in the United States

Timely access to verified burn centers is associated with improved survival and functional outcomes after severe burn injury, yet no contemporary study has jointly characterized county-level burn center access, rural-urban gradients, and socioeconomic disparities using updated burn center data.

To estimate county-level drive time to the nearest verified burn center across the contiguous US and to characterize regional, rural-urban, and income-related disparities in access.

This was a cross-sectional, population-based geospatial analysis of counties in the contiguous US, including Washington, DC. Data were from 2020 population-weighted county centroids, geocoded verified burn center locations from the American Burn Association and BurnSurvivor.com directories, 2020 Rural-Urban Commuting Area classifications, and 2022 American Community Survey median household income. Data were analyzed December 2025.

County rural-urban classification (metropolitan, micropolitan, small town, and rural) and US census region (Northeast, Midwest, South, and West).

Road-network drive time from each county's population-weighted centroid to the nearest verified burn center, estimated using the Google Maps Distance Matrix API; unweighted and population-weighted mean and median drive times nationally and by region; proportion of counties and population with drive times exceeding 2 and 4 hours; and the association between drive time and median household income.

Among 3109 counties (population, 329 260 619), the unweighted mean (SD) drive time was 1.96 (1.47) hours (median [IQR], 1.61 [1.02-2.39] hours) vs a population-weighted mean of 0.92 hours (median, 0.59 hours). Overall, 1107 counties (35.6%; 10.8% of the population) had drive times exceeding 2 hours, and 266 counties (8.6%; 1.7% of the population) exceeded 4 hours. The West had the greatest drive time burden (mean [SD], 3.08 [2.10] hours; 262 of 414 counties [63.3%] >2 hours) and the Northeast the least burden (mean [SD], 1.24 [0.74] hours; 35 of 218 counties [16.1%] >2 hours). Rural and small town counties had longer median drive times (1.76 [IQR, 1.26-2.53] hours and 2.18 [IQR, 1.54-3.27] hours, respectively) than metropolitan counties (0.86 [IQR, 0.47-1.58] hours). Lower income was associated with longer drive time nationally (R2 = 0.100) and regionally (R2 range, 0.070-0.273), most strongly in the West.

In this cross-sectional study of 3109 US counties, substantial disparities in drive time access to verified burn centers existed, concentrated among rural, small town, and Western counties, and were attenuated, although not eliminated, when weighted by population. These findings may inform burn system regionalization, aeromedical transport planning, and telemedicine expansion for underserved areas.