Abstract Background Social determinants of health (SDOH) have been shown to contribute to disparities in burn outcomes. This study leverages patient data from a regional burn center serving Texas and New Mexico to evaluate whether national indices of social vulnerability accurately predict in-hospital mortality among burn patients from underserved areas. Methods We conducted a retrospective cohort study of 1,841 patients treated for burn injuries over a five year period (2019-2024). 16 ZIP code–level SDOH metrics including Social Vulnerability Index (SVI) and Socioeconomic Status (SES) were quantified. Univariate and multivariable logistic regression analyses were performed to assess the impact of SDOH on mortality. Patients were stratified into quartiles to explore dose-response relationships. Results In univariate analysis, higher SES scores (indicating greater deprivation) was the strongest SDOH metric associated with mortality (OR = 6.28, p = 0.0018). In multivariable analysis, patients in the most deprived SES quartile (Q4) had more than double the odds of mortality compared to the least deprived (Q1) (OR = 2.20, p = 0.0199). Significant clinical predictors included age, second- and third-degree TBSA, alcohol use disorder, COPD, and obesity. SVI was not independently associated with mortality after adjustment. Conclusion SES was an independent predictor of in-hospital burn mortality in this regional cohort after adjusting for clinical factors. Other aggregate scores poorly predicted mortality after controlling clinical variables. This is potentially due to the influence of urban demographics of these indices. Further research should investigate metrics to better capture rural SDOH to improve rural burn care.
Miller et al. (2026) studied this question.