Sex-Based Differences in Inpatient Burn Mortality

World J Surg. 2019 Dec;43(12):3035-3043. doi: 10.1007/s00268-019-05165-x.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Burn Units / statistics & numerical data
  • Burns / mortality*
  • Burns, Inhalation / mortality
  • Comorbidity
  • Diabetes Mellitus, Type 2 / mortality
  • Female
  • Hospital Mortality*
  • Hospitalization / statistics & numerical data
  • Humans
  • Inpatients
  • Kaplan-Meier Estimate
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • North Carolina / epidemiology
  • Retrospective Studies
  • Risk Assessment / methods
  • Sex Factors