A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

About half a million Americans are treated for burn injuries each year. A burn injury may result from a fire or contact with electricity, chemicals, or hot liquids. People with burn injuries may experience long-term disabilities that may affect their community integration; specifically, their participation in work, social, and leisure activities. Past research has found that people from racial/ethnic minority groups, particularly Black and Hispanic Americans, may face more difficulties after a burn injury than White Americans. Black and Hispanic Americans are more likely than White Americans to experience lasting health problems after a burn injury and are less likely to return to work in the first year after a burn injury than White Americans.

In a recent NIDILRR-funded study, researchers looked at the levels of community integration reported by White, Black, and Hispanic Americans during the first two years after burn injury. They wanted to find out how individuals’ levels of community integration changed over those first two years after a burn injury. They also wanted to find out if levels of community integration differed between White, Black, and Hispanic Americans.

Researchers at the Boston-Harvard Burn Injury Model System Center and the Northwest Regional Burn Model System Center looked at data from 1,773 individuals who received burn injury treatment at the six burn centers participating in the Burn Model Systems (BMS) in Colorado, Maryland, Massachusetts, Texas, and Washington. The individuals were at least 18 years old, had surgical treatment and rehabilitation for a burn affecting at least 20% of their total body surface area (or at least 10% if older than age 65), and identified themselves as either White, Black, or Hispanic. These individuals completed questionnaires on a regular basis after discharge from the rehabilitation center. For this study, the researchers looked at community integration data from these individuals. Specifically, the individuals answered a set of questions immediately after discharge to describe their level of community integration before their injuries, and then completed the same set of questions 6 months, 1 year, and 2 years after discharge. The questions asked how much the individuals were participating in home activities (such as chores or shopping), social activities (visiting friends), and productive activities (working, studying, or volunteering). The researchers also looked at data from the BMS records on each individual’s age, sex, length of stay at the rehabilitation center, the size of the burn, and whether or not the burn impacted their range of motion.

The researchers found that:

• Regardless of race/ethnicity, the individuals reported lower community integration 6 months after their discharge when compared to their pre-injury activities. Their community integration level then improved slightly 1 year after discharge and plateaued at 2 years after discharge but remained lower than their pre-injury levels.
• There were differences in loss of community integration between White individuals and Black and Hispanic individuals. For example, while the White individuals’ average community integration scores decreased by 7% in the first 6 months after discharge, the black individuals’ scores decreased by 13% and the Hispanic individuals’ scores decreased by 11%. While all three groups experienced slight improvements at 1 year, the scores at that time were still lower for Black and Hispanic individuals than for White individuals.
• These patterns held up even after accounting for age, sex, burn size, length of rehabilitation stay, and whether or not the burn caused a loss of range of motion.

The authors noted that racial/ethnic disparities in community integration after burn injury may occur for several reasons. Racial/ethnic minorities, such as Black and Hispanic Americans, may have difficulty accessing rehabilitation services intended to support their social and occupational recovery after injury. They may face employment discrimination making it more difficult to return to work after injury, compared with White Americans. Previous research has shown that Black and Hispanic individuals have a higher risk of health-related complications after burn injury than White individuals, which may impact their return to the community. Further, the authors noted that Black and Hispanic Americans may be more likely than White Americans to live in extended families where they may receive support from family members, facilitating less independence at home.

According to the authors, rehabilitation providers serving people with burn injuries may wish to develop culturally competent programming targeting the unique values and needs of individuals from racial/ethnic minority backgrounds. More generally, burn injury rehabilitation clinicians may wish to prioritize social and occupational wellness to improve long-term community integration for people with burn injuries.

To Learn More

The Model Systems Knowledge Translation Center offers a wealth of information resources developed with research from the BMS centers. These include videos, factsheets, and hot topic modules on returning to work, social interaction, resilience, and many more topics.

The BH-BIMS has developed the LIBRE Profile, an innovative system for measuring a return to life after burn injury. The computer-based questionnaire can help burn survivors and clinicians track recovery, improve rehabilitation efforts, and identify areas where additional support is needed. Learn more about the LIBRE Profile and how individuals with burn injuries can help in its development and testing.

To Learn More About this Study

Pierce, B.S., et al. (2020) Racial/ethnic disparities in longitudinal trajectories of community integration after burn injury. American Journal of Physical Medicine and Rehabilitation, 99(7), 602-607. This article is available from the NARIC Collection under Accession Number J84444.