ReviewSocial and economic factors associated with the risk of burn injury
Introduction
Over one million burns occur in the United States each year. Approximately 5000 of these injuries are fatal, making burns the fourth leading cause of death from unintentional injury [1]. The risk of burn injury is even higher in developing countries where living conditions are substandard and access to burn care is limited [2].
Most burns are preventable, as evidenced by declining burn incidence rates in the United States that have largely been attributed to prevention strategies, such as safe sleepwear, proper use of smoke alarms, and more stringent building codes. Still, burns are consistently listed as one of the top ten causes of injury and death for children less than 5 years and adults older than 34 years [3]. Even though the age-adjusted death rate from fire/burn injuries has decreased 33% since 1985, the USA still has the highest per capita burn death rate of any industrialized nation in the world [4]. Lifetime costs per burn death are almost four times those for cancer and six times those for heart disease [1]. In the United States, federal, state, and local governments bear 28% of the direct costs of injuries [1].
Differences in health outcomes by socioeconomic status (SES) are recognized as a persistent public health problem. SES indicators such as education, income, and occupation are inversely related to death from all causes. These differences in mortality persist even after controlling for health behavior risk factors [5]. Differences in exposure to health hazards, inequities regarding access to health care, and socioeconomic stratification resulting in lack of social support and increased levels of stress may help explain social inequalities in mortality [5].
Low SES status has been associated with increased risk of unintentional injury [6], [7], [8] and mortality [9], [10], [11], [12]. SES indicators impact risk by either modifying human behavior or by increasing the exposure to environmental hazards [11]. Despite successful prevention efforts aimed at decreasing injury risk in low SES populations, the differences in injury mortality rates across SES levels has actually increased [11], [13]. A myriad of studies from around the globe have associated SES with risk of injury; yet cross-country comparisons are difficult because variables defining SES are ill-defined, inconsistent, and often unique to the general sociocultural environment of the population studied.
SES risk factors for burn have been identified in the literature but the relative significance of these findings across populations and cultures is not known. In the United States, the death rates from burn in Native Americans and blacks are two and three times greater than in whites. Furthermore, burn and death rates from unintentional burns are higher in rural areas, particularly for blacks and Native Americans [1], [14]. These differences are most likely a reflection of SES, as racial differences in house fire deaths are negligible in higher income areas [15].
A review of SES indices predictive of burn risk is warranted to better define at-risk populations and identify modifiable factors towards which intervention efforts can be targeted.
This literature synthesis addresses three questions related to SES factors and burn risk. First, what SES factors are associated with burn risk? Second, are these factors generalizable across burn injury types, the life span, communities, and cultures? Third, which of these factors are modifiable, and thus amenable to intervention strategies? The results from this synthesis can be used in the development of more specific etiologic studies examining SES factors and burn risk in specific communities, and in the design of targeted intervention/prevention programs.
Section snippets
Database search
EBSCOhost was used to search MEDLINE, CINAHL, ERIC, and PsycInfo (January 1992–September 2006) using the keywords fire or burns and socioeconomic factors or social class or social environment. Titles and abstracts from original studies in English involving humans were reviewed for relevancy. In addition, the Cochrane Library was searched for relevant reviews pertaining to SES factors and burn risk. Lizt.com, a search engine for online e-zines, was also searched for additional references. The
Results
A total of 34 articles published between January 1992 and September 2006 in peer-reviewed journals were selected for inclusion in this synthesis. Five articles pertained to SES factor variations in all injuries, but included primary data concerning burn risk factors [17], [18], [19], [20], [21]. The remaining studies described specific SES factors associated with burn [2], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
Conclusions
This review identified a number of factors related to SES that contribute to risk of burn and death. The studies reviewed were from both developing and industrialized countries, and the indices used to describe SES reflected the myriad of societies and cultures represented. Even though SES variables and outcomes definitions varied from study to study, some general conclusions about SES and burn risk can be suggested. First, burn risk is associated with poverty, lack of education and
Conflicts of interest
There are no conflicts of interest.
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