58 The Homelessness Crisis and Burn Injuries: A Cohort Study

Abstract

Abstract Introduction Many metropolitan areas face a growing homelessness crisis. Lower socioeconomic status has been shown to be a consistent risk factor for burn injury; however, only a limited number of studies have specifically examined homeless burn patients. The purpose of this study is to characterize the demographics and outcomes of homeless patients who sustain burn injuries and compare them to a cohort of domiciled patients in a large, metropolitan city. Methods A retrospective cohort study was performed at an ABA-verified center located in a major metropolitan area. Consecutive acute burn admissions in adults from June 1, 2015 to December 31, 2018 were included. Prevalence was estimated using data from the regional homeless count. Comparisons of demographics, burn characteristics, clinical outcomes, and disposition were made between patients categorized homeless or domiciled at the time of their injury. Results Of 881 admissions, 751 (85%) had stable housing, and 130 (15%) were homeless. The mean prevalence rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7% vs 5%, p< 0.05), characterized by a greater rate of flame burns (68% vs 42%, p< 0.001). For the homeless, rates of assault and self-inflicted injury were four- (18% vs 4%, p< 0.001) and two-fold higher (9% vs 4%, p< 0.001), respectively. Homeless patients had higher rates of mental illness (32% vs 12%, p< 0.001) and substance abuse (88% vs 22%, p< 0.001), and were less likely to follow-up as outpatients (54% vs 87%, p< 0.001). There were no significant differences in mortality. Homeless patients had a longer median length of stay (LOS, 11 days vs 7 days, p< 0.001), but there were no significant differences in LOS per %TBSA. Homeless patients had more complex discharge dispositions and were more frequently discharged to a recuperative care facility than domiciled patients (27% vs. 1%, p< 0.001). Conclusions Homeless patients comprised a significant subset of our adult inpatient population, with an estimated five-fold greater rate of burn injury requiring hospitalization compared to the national average. These patients sustained larger burn injuries with greater rates of assault or self-inflicted injury. Applicability of Research to Practice Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.