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Sociodemographic Predictors Of Morbidity And Mortality Among Pediatric Burn Patients In The United States
Ryan Keyho, Bachelor of Science, Alfredo Cepeda, MD, Wendy Chen, MD, Matthew Greives, MD, Phuong Nguyen, MD.
University of Texas Health Science Center at Houston- McGovern Medical School, Houston, TX, USA.

PURPOSE: Health and health outcomes particularly morbidity and mortality have been linked to sociodemographic factors such as race, income, and insurance status. There is a relative paucity of information linking these factors to outcomes in pediatric burns in the U.S. Herein, we examined sociodemographic factors as predictors for morbidity and mortality among pediatric burn patients using the 2016 Kids' Inpatient Database (KID).
METHODS: The 2016 KIDs was used to select patients with primary and secondary ICD-10 diagnosis of burns (T30.0 and T31.0). Demographics of this cohort regarding racial, financial, and insurance status composition were identified. Multinominal logistic regression analysis was performed to assess race, income quartile, and insurance status as significant predictors for morbidity level and mortality risk using All Patient Refined-Diagnostic Related Group (APRDRG). Statistical analyses were conducted in STATA using an α<0.05 for determining statistical significance of predictors.
RESULTS: 6906 patients were identified that met inclusion criteria. Risk of morbidity among patients with primary or secondary burn diagnoses among different races was assessed, showing that compared to white patients, Hispanic patients had 1.29 times the risk of having "major loss of function". When analyzing income, we found that those in the lowest income quartile ($1-42999) had 1.64 times the risk of having "extreme loss of function" compared to those in the highest income quartile ($71000+). Analyses of risk among different insurance statuses revealed that compared to those using private insurance methods, those who were uninsured, or self-pay had 2.09 times the risk of having "extreme loss of function". Figure 1Among different racial groups there were no differences in mortality risk among pediatric burn patients. When examining income quartiles, we found that those in the lowest two quartiles ($1-42999) ($43000-53999) had 2.29 and 2.53 times "major likelihood of dying" risk respectively compared to the highest income quartile ($71000+). Examining mortality risk among insurance groups revealed that those who were uninsured or self-pay had 2.10 times "major likelihood of dying" risk compared to those using private insurance. Figure 2
CONCLUSION:
Certain sociodemographic factors significantly increase the risk of morbidity and mortality among pediatric burn patients. Hispanic individuals were found to at significantly higher risk of having increased morbidity compared to white patients, those in the lower-income quartiles had significantly more risk of morbidity and mortality compared to those in the highest income quartile, and those who were uninsured had significantly more risk of morbidity and mortality compared to those using private insurance. To our knowledge this is the first study to assess sociodemographic factors in relation to morbidity and mortality among pediatric burn patients utilizing the KIDs and APRDRRG classification. These findings highlight the need to inform future health care policy and health education amongst at-risk vulnerable socioeconomic groups.


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