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Sex-Based Differences in Inpatient Burn Mortality

  • Felicia N. WilliamsEmail author
  • Paula D. Strassle
  • Laquanda Knowlin
  • Sonia Napravnik
  • David van Duin
  • Anthony Charles
  • Rabia Nizamani
  • Samuel W. Jones
  • Bruce A. Cairns
Original Scientific Report
  • 12 Downloads

Abstract

Background

Among burn patients, research is conflicted, but may suggest that females are at increased risk of mortality, despite the opposite being true in non-burn trauma. Our objective was to determine whether sex-based differences in burn mortality exist, and assess whether patient demographics, comorbid conditions, and injury characteristics explain said differences.

Methods

Adult patients admitted with burn injury—including inhalation injury only—between 2004 and 2013 were included. Inverse probability of treatment weights (IPTW) and inverse probability of censor weights (IPCW) were calculated using admit year, patient demographics, comorbid conditions, and injury characteristics to adjust for potential confounding and informative censoring. Standardized Kaplan–Meier survival curves, weighted by both IPTW and IPCW, were used to estimate the 30-day and 60-day risk of inpatient mortality across sex.

Results

Females were older (median age 44 vs. 41 years old, p < 0.0001) and more likely to be Black (32% vs. 25%, p < 0.0001), have diabetes (14% vs. 10%, p < 0.0001), pulmonary disease (14% vs. 7%, p < 0.0001), heart failure (4% vs. 2%, p = 0.001), scald burns (45% vs. 26%, p < 0.0001), and inhalational injuries (10% vs. 8%, p = 0.04). Even after weighting, females were still over twice as likely to die after 60 days (RR 2.87, 95% CI 1.09, 7.51).

Conclusion

Female burn patients have a significantly higher risk of 60-day mortality, even after accounting for demographics, comorbid conditions, burn size, and inhalational injury. Future research efforts and treatments to attenuate mortality should account for these sex-based differences. The project was supported by the National Institutes of Health, Grant Number UL1TR001111.

Notes

Acknowledgements

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award No. UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by our institutional review board (IRB).

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Felicia N. Williams
    • 1
    • 2
    Email author
  • Paula D. Strassle
    • 1
    • 3
  • Laquanda Knowlin
    • 4
  • Sonia Napravnik
    • 3
    • 5
  • David van Duin
    • 5
  • Anthony Charles
    • 1
  • Rabia Nizamani
    • 1
    • 2
  • Samuel W. Jones
    • 1
    • 2
  • Bruce A. Cairns
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of SurgeryNorth Carolina Jaycee Burn CenterChapel HillUSA
  3. 3.Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of SurgeryHoward UniversityWashingtonUSA
  5. 5.Division of Infectious DiseasesUniversity of North Carolina School of MedicineChapel HillUSA

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