Social and Medical Determinants of Burn-Related Mortality in Isfahan, Iran


1 Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 School of Management and Medical Information Sciences, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Health Services Management, School of Management and Medical Information Sciences and Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Burns and heat-related injuries often lead to mortality and great financial and social costs. This study aimed at investigating the social determinants of burn-related mortalities in a burn specialized hospital in Isfahan, Iran. Materials and Methods: This cross-sectional data secondary analysis study was conducted through the data related to burn patients hospitalized to bur specialized Imam Musa Kazim hospital, Isfahan, Iran, in a 4-year period. The data were extracted using Hospital’s Information System, and analyzed descriptively and inferentially. Results: Among 3290 burn patients, 740 (22.49%) had passed away. The highest mortality percentage was observed in women (31.1%), aged higher than 60 years old (35.8%), in patients with low-financial status (27.4%), patients come from cities other than Isfahan (25.4%), and in Total Burn Surface Area (TBSA) of higher than 71% (86.6%). The results of logistic regression test showed that burn-related mortality is 50% lower in men compared to women (odds ratio [OR] = 0.50), 16% lower in 41-60 years of age group compared to over 60 years of age group  (OR = 0.16), 41% higher in people with low financial status compared to those with high financial status (OR = 1.41) and 4% lower in people
with 31–70 TBSA compared to those with TBCA higher than 71% (OR = 0.04). Conclusion: Bur related mortality could be associated with treatment and health care as well as social factors. Therefore, parallel to hospital care and physical conditions of the burn patients, social factors including gender, age, income level, and place residence need to be addressed in burn policies to reduce burn-related mortalities.


1. Panjeshahin MR, Lari AR, Talei A, Shamsnia J, Alaghehbandan R. Epidemiology and mortality of burns in the South West of Iran. Burns 2001;27:219-26. 
2. World Health Organization. AWHO Plan for Burn Prevention and Care. World Health Organization; 2008. 
3. World Health Organization. Burn Prevention: Success Stories and Lessons Learned. World Health Organization; 2011. 
4. Atiyeh B, Masellis A, Conte C. Optimizing Burn Treatment in Developing Low-and Middle-Income Countries with Limited Health Care Resources (Part 2). Ann Burns Fire Disasters 2009;22:189-95. 
5. National Center for Injury Prevention and Control: Web-Based Injury and Statistics Query and Reporting System (WISQARS™) Injury Mortality Reports, 1981–2016. Atlanta, GA: Centers for Disease Control; 2018. Available from: mortrate9.html. [Last accessed on 2018 Nov 04]. 
6. Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns 2011;37:1087-100. 
7. Outwater AH, Ismail H, Mgalilwa L, Justin Temu M, Mbembati NA. Burns in tanzania: morbidity and mortality, causes and risk factors: A review. Int J Burns Trauma 2013;3:18-29. 
8. World Health Organization. Social Determinants of Health. World Health Organization; 2018. 
9. Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, et al. Recent trends in burn epidemiology worldwide: A systematic review. Burns 2017;43:249-57. 
10. Cheng W, Wang S, Shen C, Zhao D, Li D, Shang Y. Epidemiology of Hospitalized Burns Patients in China: A Systematic Review. Burns Open. 2018;2:8-16. 
11. Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health; 2010. 
12. Amir Alavi S, Mobayen MR, Tolouei M, Noursalehi I, Gholipour AG, Gholamalipour N, et al. Epidemiology and outcome of burn injuries in burn patients in Guilan province Iran. Qom Univ Med Sci J 2013;7:35-41. 
13. Azizi AA, Zarei J, Nabovati E, Vakili-Arki H, Abbasi E, Razavi AR. Determining of the factors affecting mortality in burn patients using a decision tree data mining algorithm. Health Manage 2013;16:34-45. 
14. Rae L, Pham TN, Carrougher G, Honari S, Gibran NS, Arnoldo BD, et al. Differences in resuscitation in morbidly obese burn patients may contribute to high mortality. J Burn Care Res 2013;34:507-14. 
15. Xu H, Gu J, Lau JT, Zhong Y, Fan L, Zhao Y, et al. Misconceptions toward methadone maintenance treatment (MMT) and associated factors among new MMT users in Guangzhou, China. Addict Behav 2012;37:657-62. 
16. Wardhana A, Basuki A, Prameswara AD, Rizkita DN, Andarie AA, Canintika AF. The epidemiology of burns in Indonesia’s national referral burn center from 2013 to 2015. Burns Open 2017;1:67-73. 
17. Batra AK. Burn mortality: Recent trends and sociocultural determinants in rural India. Burns 2003;29:270-5. 
18. Theodorou P, Xu W, Weinand C, Perbix W, Maegele M, Lefering R, et al. Incidence and treatment of burns: A twenty-year experience from a single center in Germany. Burns 2013;39:49-54. 
19. Parvareh M, Hajizadeh M, Rezaei S, Nouri B, Moradi G, Esmail Nasab N. Epidemiology and socio-demographic risk factors of self-immolation: A systematic review and meta-analysis. Burns 2018;44:767-75. 
20. Kumar S, Ali W, Verma AK, Pandey A, Rathore S. Epidemiology and mortality of burns in the Lucknow Region, India—a 5 year study. Burns 2013;39:1599-605. 
21. Shahabi Shahmiri S, Kolahdouzan M, Omrani A, Khazaei M, Salehi H, Motavalian A, et al. Determinants of mortality and the lethal area 50 index (LA50) in Burn patients admitted to a large burn center; A single center experience. Bull Emerg Trauma 2017;5:184-9. 
22. Al-Shamsi M, Othman N. The epidemiology of burns in Basra, Iraq. Ann Burns Fire Disasters 2017;30:167-71. 
23. He S, Alonge O, Agrawal P, Sharmin S, Islam I, Mashreky SR, et al. Epidemiology of Burns in Rural Bangladesh: An Update. Int J Environ Res Public Health 2017;14: pii: E381. 
24. Queiroz LF, Anami EH, Zampar EF, Tanita MT, Cardoso LT, Grion CM. Epidemiology and outcome analysis of burn patients admitted to an intensive care unit in a university hospital. Burns 2016;42:655-62. 
25. Soltani K, Zand R, Mirghasemi A. Epidemiology and mortality of burns in Tehran, Iran. Burns 1998;24:325-8. 
26. Tripathee S, Basnet SJ. Epidemiology of burn injuries in Nepal: A systemic review. Burns Trauma 2017;5:10. 
27. Baqir SM, Ejaz K. Role of Pre-Hospital Care and Ambulance Services in Karachi; 2011. 
28. Shrivastava P, Goel A. Pre-hospital care in burn injury. Indian J Plast Surg 2010;43:S15-22. 
29. Spanholtz TA, Theodorou P, Amini P, Spilker G. Severe burn injuries: Acute and long-term treatment. Dtsch Arztebl Int 2009;106:607-13. 
30. Tung KY, Chen ML, Wang HJ, Chen GS, Peck M, Yang J, et al. A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan—using the Internet registration system of the Childhood Burn Foundation. Burns 2005;31 Suppl 1:S12-7. 
31. Ahmadabadi A, Khadem-Rezaiyan M, Sedaghat A, Tavousi SH, Khorrampazhouh N, Mohsenpour A, et al. Lethal area 50 percent (LA50) or standardized mortality ratio (SMR): Which one is more conclusive? Burns 2018;44:1468-74. 
32. Li H, Wang S, Tan J, Zhou J, Wu J, Luo G. Epidemiology of pediatric burns in southwest China from 2011 to 2015. Burns 2017;43:1306-17. 
33. Chien WC, Pai L, Lin CC, Chen HC. Epidemiology of hospitalized burns patients in Taiwan. Burns 2003;29:582-8.