Global burn injury burden disproportionately impacts low- and middle-income countries.
Surgery is a mainstay of burn treatment, yet access to surgical care appears to be
inequitably distributed for women. This study sought to identify gender disparities
in mortality and access to surgery for burn patients in the World Health Organization
Global Burn Registry (GBR).
We queried the World Health Organization GBR for a retrospective cohort (2016-2021).
Patients were stratified by sex. Outcomes of interest were in-hospital mortality and
surgical treatment. Patient demographics, injury characteristics, outcomes, and health
facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric
medians, and chi-squared or Fisher’s exact test for nonparametric proportions. Multivariable
logistic regressions were performed to assess the relationships between sex and mortality,
and sex and surgery.
Of 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were
female, with 51% of all patients receiving surgical treatment during their hospitalization.
Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis,
female sex was independently associated with mortality after controlling for age,
time to presentation, smoke injury, percent total body surface area, surgery, and
country income status. Female sex was independently associated with surgical care
(odds ratio 0.86, P = 0.001).
Female burn patients suffer higher mortality compared to males and are less likely
to receive surgery. Further study into this gender disparity in burns is warranted.