Elsevier

Burns

Volume 41, Issue 3, May 2015, Pages 437-445
Burns

Geographical analysis of socioeconomic factors in risk of domestic burn injury in London 2007–2013

https://doi.org/10.1016/j.burns.2014.12.001Get rights and content

Highlights

  • We explored the geographical distribution of burn injuries in Greater London and the association of socioeconomic factors in areas at risk.

  • Bayesian methods were used to calculate domestic burn injury risks in children and adults.

  • We found evidence of geographical clustering of calculated burn injury risks.

  • There was significant association of previously known socio-economic risk factors in burn injury at the population level.

  • However, socioeconomic factors investigated in this study may be more relevant in domestic burns risk in children as opposed to adults.

Abstract

Purpose

This study aims to explore the geographical distribution of burn injuries in Greater London and the association of socioeconomic factors in areas at risk.

Methods

Data on burn injury cases classified as occurring in patients’ own homes in Greater London and admitted to a specialised burns service for ≥1 day during a 7-year period were obtained from the International Burn Injury Database (iBID). Age- and gender-adjusted standardised incidence ratios (SIRs) were calculated for each Lower Layer Super Output Area (LSOA) in Greater London. Bayesian methods were used to calculate relative risks as best estimates of spatially-smoothed SIRs.

Results

Of a total of 2911 admissions to specialised burns services in Greater London in the study period, 2100 (72.1%) cases occurred in patients’ own homes. Percentage of ethnic minorities (p = 0.005), Income Deprivation Affecting Children Index (p < 0.001), Health Deprivation and Disability Score (p = 0.031), percentage of families with 3 or more children (p = 0.004) and Barriers to Housing and Services Score (p = 0.001) remained independently associated with the relative risk of paediatric domestic burn injury in a multivariate linear regression model. Percentage of ethnic minorities (p < 0.001), Health Deprivation and Disability Score (p < 0.001) and Barriers to Housing and Services Score (p = 0.036) remained independently associated with the relative risk of adult domestic burn injury in a multivariate linear regression model.

Conclusions

Socioeconomic factors are associated with an increased risk of burn injury in Greater London, but may be more important in children than adults. The specific factors identified are ethnicity, poor general health, household structure, housing issues and income deprivation affecting children.

Introduction

Burn injuries represent a significant health burden in the United Kingdom. Every year, there are 18.1 burn injuries per 100,000 population resulting in hospitalisation [1]. Serious burn injuries leading to death, or hospitalisation for more than 72 h, occurred in 4.7 cases per 100,000 population annually, contributing to 5.4% of all serious traumatic injuries [1]. Burn injuries are associated with a significant risk of mortality [2], as well as significant physical, functional and psychiatric sequelae in survivors. The economic costs to the health service are also substantial, with the cost of short-term care for a hot drink scald estimated at £1850, and the cost of a major paediatric burn estimated at £63,157. Given the significant costs of burn injuries to the individual and society, the potential benefit of targeted community-based preventative strategies [3] is of crucial importance in preventing burns morbidity and mortality.

The majority of burn injuries occur in the victims’ own homes [4]. Previous studies worldwide have identified significant geographic clustering of burn injuries [5], [6], [7], [8], [9], suggesting that there may be common characteristics in the resident communities that potentially pre-dispose them to burn injuries. Age [10], socioeconomic deprivation [7], [9], [10], [11], [12], ethnicity [10], [12], education status [11], [12], [13], adult employment status[12], living environment [7], household structure such as lone parent households [14] and large family size [15], as well as pre-existing disabilities [16], [17], have all been implicated in the incidence and risk of burn injuries.

In the 2011 Census of the United Kingdom population, the Greater London metropolitan area is officially the most populous city in Europe, with a population of approximately 8 million [18]. There is evidence of widespread variation in unintentional injury rates across London attributable to socioeconomic factors [19], [20], [21], [22]. However, there have not been any studies of population burn injury rates or risk in London.

This study aims to explore the geographical distribution of burn injuries in Greater London and the association of socioeconomic factors in areas at risk.

Section snippets

Data collection

The International Burn Injury Database (iBID1), incorporating the UK National Burn Injury Database (UK.NBID2), was created in 2004 [4]. This was achieved with funding from the UK National Burn Care Group (NBCG3) following the UK National Burn Care Review in 2001, with the purpose of matching the demand for burn care across a range of ages, burn injury severity and geographical

Results

There were a total of 2911 admissions to specialised burns services in Greater London in the 7-year study period. 2100 (72.1%) cases were classified as occurring in the patients’ own homes. There were 1028 paediatric (age 0–14 years) and 1071 adult (≥15 years) domestic burn injuries. The detailed characteristics of domestic burn injury cases are presented in Table 1. There were a total of 1157 males and 929 females, with gender not having been recorded in 14 cases. The median percentage of

Discussion

In our study, we found more patients admitted to burns services with burn injuries to be in the most socioeconomically deprived brackets, which is consistent with previous studies [7], [9], [10], [11], [12]. However, merely studying burn injury cases presenting to burns services gives little information about the communities these patients live in or the risk of burn injuries in the population at large. Geographic mapping provides a unique opportunity for identifying communities at high risk of

Conflict of interest statement

The authors declare no conflict of interest.

Acknowledgements

We wish to thank the International Burn Injury Database (iBID) for providing the data used in this study. We also wish to thank Professor Peter Dziewulski (St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford) and Mr Simon Booth (Burns Service, Queen Victoria Hospital, East Grinstead, West Sussex) for their help and encouragement in carrying out this study.

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