Domain-Specific Associations of Neighborhood Financial Resources and Economic Hardship with Functional Outcomes in Burn Survivors

Neighborhood disadvantage, measured by the Area Deprivation Index (ADI), is associated with long-term outcomes in burn survivors. However, prior work has relied on global scores, which may obscure domain-specific pathways linking neighborhood context to recovery. This secondary analysis of a randomized controlled trial examined whether specific ADI domains are associated, in separate adjusted models, with pain and functional outcomes in 74 adult burn survivors. Baseline addresses were linked to nationally referenced ADI scores calculated across 239,780 U.S. block groups. Three ADI-3 domains, Financial Strength, Economic Hardship, and Educational Attainment, were tested in hierarchical regressions predicting BPI Pain Severity, PROMIS Pain Interference, and BSHS Functional Abilities, controlling for demographics. The global ADI was associated with functional abilities (ΔR2 = .085, p = .012) but not pain outcomes. Domain-specific analyses revealed that both Financial Strength (β = 2.55, p-FDR = .012) and Economic Hardship (β = -2.22, p-FDR = .031) were each associated with functional abilities after multiple comparison correction, remaining robust in sensitivity analyses. A suggestive trend was observed between Financial Strength and pain severity (β = -0.52, p-FDR = .057), but this did not survive multiple comparison correction. No associations were observed for pain interference or Educational Attainment. These findings suggest that Financial Strength and Economic Hardship were domain-specific contextual correlates of functional abilities not apparent in the global index. The null pain findings alongside significant functional associations suggest neighborhood context may be more closely associated with daily functioning than with pain perception.