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Drivers of the Geographic Distribution of Pediatric Burns
Marcelo Cerullo MPH, Sandra R. DiBrito MD, Seth D. Goldstein MD PhD, Susan Ziegfeld PNP-BC, Dylan Stewart MD, Isam W. Nasr MD. Johns Hopkins School of Medicine, Department of Surgery, Division of Pediatric Surgery, Baltimore, MD, USA.

Background: The geographic distribution of pediatric burn injuries in socioeconomically diverse urban area remains underexplored. This study investigated the association between the geospatial clustering of burn injuries in a major mid-Atlantic city, including socioeconomic indicators.

Methods: Pediatric emergency department visits for burns between January 1, 2000 and December 31, 2015 were identified via a regional burn center registry. Patient address was used to geographically aggregate cases by census block group. Census data was obtained via the 2007-2011 American Community Survey 5-year estimates. Monte-Carlo Moran's I was used to determine clustering. Relative incidence of injuries overall and by non-accidental trauma (NAT) was explored using modified Poisson regression.

Results: Exactly 838 cases (39 NAT) were identified over 382 census blocks (Figure). Clustering by census block was significant (Moran's I p-value <0.001). Poisson regression demonstrated a significant association between incidence of burns and percent of population living below the poverty line (IRR = 2.39, 95% CI: 1.18-4.76, p=0.014). Moran's I for clustering of NAT cases was non-significant, and no association was found between incidence of non-accidental burn and percent living below poverty, educational attainment (high-school or college), or household property value or gross rent.

Conclusions: Areas with high poverty have a high incidence of burns, as demonstrated by geospatial clustering. However, cases of NAT did not cluster, suggesting a lack of an association with certain socioeconomic factors.

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