The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature

Abstract

Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.

Disparities in Access to Postmastectomy Breast Reconstruction: Does Living in a Specific ZIP Code Determine the Patient’s Reconstructive Journey?

“…These disparities unfortunately can lead to a cascade of problems that could ultimately jeopardize patients’ health care management and negatively impact surgical outcomes 38–41 . Plastic surgery is no exception 42–47 . Epstein et al 44 in 2018 assessed an indexed national database and found that racial disparities in postmastectomy BR persists; however, progress has been evidenced.…”

“…[38][39][40][41] Plastic surgery is no exception. [42][43][44][45][46][47] Epstein et al 44 in 2018 assessed an indexed national database and found that racial disparities in postmastectomy BR persists; however, progress has been evidenced. The authors showed that the disparity index in BR decreased up to 28.8% (from 51.4% to 22.6%).…”

Trends and Clinical Outcomes of Major Burns in an Underserved Minority Population within a Large Metropolitan Area: A Cross-sectional study

“…Minority populations (e.g Black and Hispanic) were more likely to have higher complication rates after burn injury such as urinary tract infections, contractures, increased length of stay. [3] Various cultural and environmental exposures predispose certain ethnic groups to burn injuries, which if identi ed can be the target for culturally-tailored interventions aimed at raising awareness to reduce occurrences.…”

Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study

“…Minority pediatric patients are at higher risk for trauma exposure but have increased barriers to mental and medical healthcare [ 11 – 13 ]. Hispanic pediatric patients are at increased risk of intentional burn injury, inhalational injury, and larger burn sizes [ 14 ]. Regarding psychosocial outcomes, minority pediatric patients report increasing rates of depression, post-traumatic stress disorder, substance use disorder, and suicide [ 11 , 15 ].…”

“…These disparities are hypothesized to be influenced by inequities in socioeconomic status, healthcare status, and cultural factors [ 19 ]. In one study, 85% of parents of racial and ethnic minority patients report never receiving education regarding burn prevention or care [ 14 ]. Risk factors for burn injury, such as crowded households, simultaneous cooking and supervising children cultures, or even hair braiding practices, in minority patients have been identified, but investigations regarding post-burn outcomes in pediatric minority populations are lacking [ 7 , 14 , 18 , 20 ].…”