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Regional disparities in community reintegration after burn injury: A multi-site comparison of clinical and structural
Pyung Kim1, Kristine J Hahm2, Dohyeong Kim2
1Center for Spatial Studies and Data Science, University of California, Santa Barbara, USA.
Purpose:
This study examines regional differences in community reintegration outcomes among burn survivors treated at three major U.S. burn centers and asks whether those differences are associated with where patients live.
Methods:
We used data from 531 adult burn survivors in the Burn Model System (BMS) National Database, treated at centers in Seattle, Dallas, and Boston between 2015 and 2023. We linked individual-level clinical and demographic data with county-level structural variables from the Urban Institute and compared Community Integration Questionnaire (CIQ) change scores across centers, alongside patient characteristics and residential community conditions.
Results:
Dallas patients experienced a significantly greater decline in CIQ scores at six months post-injury than Seattle patients (∆ = -0.71, p = .004), while Boston patients showed outcomes comparable to Seattle (∆ = -0.27, p = .276). Clinical characteristics did not differ significantly between Dallas and Seattle. Dallas patients lived in counties with substantially worse economic conditions than Seattle patients, including lower household income at the 20th percentile, higher debt burden, lower economic connectedness, and higher crime rates. Boston patients lived in counties that did not show this pattern of disadvantage, remaining comparable to or more favorable than Seattle's on the same indicators.
Conclusions:
Community reintegration after burn injury varies systematically across burn centers in ways that correspond to differences in the structural conditions of communities patients return to. These findings highlight the need to incorporate residential community conditions into burn rehabilitation planning and discharge support.
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