Lost to Follow Up: Disparities in the Burden of Pediatric Burn Injury and Access to Follow up Care

Background: Previous work has emphasized the impact of health inequities on patients’ access and return to care after burn injury. While adult patients who do not return to outpatient follow up may require more emergent visits and hospitalizations, these trends remain understudied for pediatric burn patients, especially at intersections with race and socioeconomic status. This study compares the burn injury burden and post-discharge care access of a 7-year cohort of pediatric burn patients based on these factors.

Methods: Between 2009-2016, patients aged 18 years or younger presenting with a burn injury were retrospectively reviewed across an institutional network in Southern Connecticut. Burn injury burden was mapped across Connecticut and compared between demographic groups. Distributions of 1-month post-discharge care access types and locations were also compared between racial and socioeconomic groups.

Results: Of 1281 patients, 36% were Black/African American and 28% White/Caucasian; 35% were Hispanic/Latinx. Mean age at injury was 6.21±0.20 years and 47% were female. There were 471 (37%) patients whose zip code was associated with a median household income below the threshold of $37,000, with densest burn incidence occurring in the areas with lowest median household income, Figure.

In the month after discharge, White/Caucasian patients scheduled outpatient follow-up appointments more frequently, whereas a larger proportion of Black/African American patients cancelled or did not attend these appointments (Table, p<0.0001). Hospitalizations were more frequent in White/Caucasian patients during this period (B=153/461, 33%; W=157/362, 43%; p=0.0030), but 11% of Black/African American patients (52/461) visited the emergency department compared to 7% of their White/Caucasian counterparts (25/362, p=0.0399).

Similarly, patients from zip codes associated with median household income <$37,000 cancelled 22% (98/438) or did not attend 7% (32/438) of outpatient follow-up appointments, whereas those above the threshold cancelled 19% (169/879) and did not attend 4% (32/879, p=0.0033). A smaller proportion of the <$37,000 group had hospitalizations (130/471, 28%, versus 308/810, 38% of $37,000+; p=0.0002) while a larger proportion visited the emergency department (58/471, 12%, versus 69/810, 9% of $37,000+; p=0.0328).

Conclusion: Within our 7-year pediatric cohort, Black/African American patients and those from poorer neighborhoods had a higher burden of burn injury but missed follow-up appointments more frequently and had more emergent visits in the month after admission. These trends may suggest a relationship between the disparities in burn burden and the potentially prolonged lack of treatment of post-injury complications in the same groups, resulting in more frequent emergent hospitalizations. Future interventions must focus on the specific needs of these patients while addressing their disparate access to outpatient, inpatient, and emergency care for post-discharge concerns.