The Unhoused State, Not Area Deprivation Index, Is an Independent Risk Factor for Resistant Infections in Burn Patients

<b><i>Background:</i></b> Patients with burn injuries are especially prone to infections; however, the influence of socioeconomic status on infection following burn injury remains poorly understood. This study aimed to evaluate the association between socioeconomic disadvantage and risk of infection among burn patients. We hypothesize that burn patients with more socioeconomic disadvantage have an increased risk of infections. <b><i>Patients and Methods:</i></b> The burn registry of an American Burn Association-verified burn center was queried for all admissions from 2015 to 2019. Patients admitted for <7 days or with a home address outside California were excluded. Collected data included demographics, burn characteristics, and culture results. Patient home addresses were geocoded, and correlated Area Deprivation Index (ADI) scores were classified into quintiles. Unhoused patients were classified as a separate category. Groups were then compared using univariate and multivariate analysis. The primary outcome was any infection. Resistant infections were analyzed as a secondary outcome. <b><i>Results:</i></b> Overall, 788 patients were included for analysis. The median ADI state decile was 6 (interquartile range = 5-8); 4.6% (n = 36) of patients were unhoused. 16.6% (n = 131) of patients had an infection during admission, whereas 6.3% (n = 50) had an infection with a resistant organism. Risk factors for having an infection included age (p < 0.001), percent total body surface area burned (p < 0.001), and diabetes mellitus (0.004). ADI quintile was not associated with infection. The unhoused state was an independent risk factor for resistant infection (odds ratio = 3.37, 95% confidence interval = 1.05-9.31, p = 0.027). <b><i>Conclusions:</i></b> ADI was not associated with an increased risk of infection, but unhoused patients are at increased risk of developing an infection with a resistant organism during admission for a burn injury.