“In high-income countries, men more often sustain burn injuries than women,” explains Lincoln M. Tracy, PhD. “The ratio is approximately two men for every woman. Despite this ratio, women have an increased risk of mortality following burn injury, and those who survive their injuries have a lower quality of life compared with men. It is important to understand why these differences occur to inform how female burn patients are managed and help improve their outcomes.”

For a paper published in ANZ Journal of Surgery, Dr. Tracy and colleagues aimed to investigate the association between gender and patients admitted to specialist burn units. “We utilized the Burns Registry of Australia and New Zealand, a database that collects data on patients with burn injuries severe enough to require admission to a hospital with specialist burn services,” he says. “We examined records from adult men and women who were admitted to intensive care to determine if there were differences in how they sustained their injury, the severity of the injury, and how the injury was managed surgically. Most importantly, we wanted to know if gender was associated with the risk of mortality and time of death.”

Women Had Greater Risk of Mortality Than Men

Among 2,227 eligible burn injury admissions in the study, the majority were men (77.6%). The proportion of women who died in the hospital was greater than that of men, with 34% lower adjusted odds (44% lower unadjusted odds) of in-hospital mortality in men. “While women had an increased risk of mortality following burn injury compared with men after adjusting for relevant confounding factors,” says Dr. Tracy, “there was no association between gender and time of death.”

Dr. Tracy notes that were also no differences between men and women in the proportion of patients who underwent surgery for a burn wound management procedure or who received a skin graft, suggesting “that men and women were managed similarly with respect to surgical procedures,” he says. “However, we observed key differences in in-hospital outcomes. Women spent more time in intensive care, and in the hospital overall, compared with men. Also, a greater proportion of women succumbed to their injuries and died in the hospital compared with men—about one in eight women compared with one in 16 men. Among patients who survived to discharge, a greater proportion of men were discharged to their home or usual residence, whereas a greater proportion of women were discharged to another hospital or healthcare facility (Table).”

Other Factors May Contribute to Gender Differences

At this stage, notes Dr. Tracy, it is not possible to make recommendations to physicians about treating patients with burns differently by gender. “We do not know what possible reasons and mechanisms may underly our findings,” he adds. “Burn clinicians need to be aware, however, that these questions exist and consider studies that may help to explain these observations. It is also critical to remember that these findings were found in Australia and New Zealand and that we cannot be certain of the generalizability to other settings.”

The need exists for well-designed prospective studies focusing on factors outside of those assessed in this study that may contribute to the observed gender differences in outcomes for patients with burns, according to Dr. Tracy. “For example, sex hormones and BMI have been linked to mortality following a burn injury,” he says. “However, due to the small number of patients who die from their acute injuries, such studies need to be done through a collaborative network of services. Alternatively, recent research from our study team has shown that more than one-third of burn-related fatalities in Australia and New Zealand from 2009 to 2015 occurred in the pre-hospital setting. Therefore, future research could incorporate collaborations with emergency services to investigate potential gender-related differences in pre-hospital deaths.”