612 Racial Differences in Post-burn Hypertrophic Scarring Incidence with Glucocorticoid Effectiveness

TL;DR

This study finds that racial differences exist in the occurrence of hypertrophic scarring after burns and that glucocorticoid treatments vary in effectiveness across racial groups.

Contribution

The study identifies racial disparities in hypertrophic scarring incidence and glucocorticoid treatment effectiveness, advocating for personalized treatment strategies.

Findings

African American and Asian patients had a significantly higher risk of hypertrophic scarring compared to White patients.

Glucocorticoids like dexamethasone and methylprednisolone showed differential effectiveness across racial groups.

Native Hawaiian patients had a decreased risk of hypertrophic scarring compared to White patients.

Abstract

Hypertrophic scarring is a frequent complication after burn injuries, with notable variation in incidence and treatment response among racial groups. Glucocorticoids are commonly used to manage hypertrophic scars, but their effectiveness may differ by race. This study aims to 1) examine racial differences in hypertrophic scarring incidence among burn patients and 2) evaluate the clinical effectiveness of glucocorticoid treatments in reducing hypertrophic scarring in African Americans, Asians, and Whites one-year post-burn injury.

Using the TriNetX Collaborative Network, we identified 633,708 burn patients aged ≥18 treated between 2013 and 2023. Patients were grouped by race: White, Black, Asian, American Indian, and Native Hawaiian. The incidence of hypertrophic scarring and the effectiveness of glucocorticoids were assessed at one month, six months, and one-year post-burn by calculating the relative risk ratio for each racial group, with White patients as the reference. Propensity score matching controlled for age, sex, and burn severity. Statistical significance was set at p< 0.05.

Among the burn patients in TriNetX database, 46,893 developed hypertrophic scarring, with 63.06% were White, 13.50% were Black or African American, 2.47% were Asian, 0.55% were Native Hawaiian, and 0.54% were American Indian. Among all patients with burns, African Americans (p< 0.0001), Asian (p< 0.0001), and Native Hawaiian ((p< 0.05) had a significantly increased risk for hypertrophic scarring compared to White burn patients. However, Native Hawaiian had significantly decreased risk for hypertrophic scarring compared to White burn patients (p< 0.05). When assessing effectiveness in glucocorticoids, hydrocortisone and triamcinolone statistically increased risk for hypertrophic scarring in Black and Asian patients compared to White burn patients (p< 0.05). However, dexamethasone decreased risk for hypertrophic scarring in African American patients but not Asians (p=0.0518) and methylprednisolone decreased risk for hypertrophic scarring in Asian patients but not African Americans (p=0.1537).

This study reveals significant racial disparities in hypertrophic scarring following burn injuries and highlights the differential effectiveness of glucocorticoid treatments across racial groups. These findings emphasize the need for personalized treatment strategies to address scarring in burn patients from diverse racial backgrounds.

The findings of this study have significant implications for the clinical management of hypertrophic scarring in burn patients. By identifying racial disparities in both the incidence of hypertrophic scarring and the differential effectiveness of glucocorticoid treatments, this research underscores the need for personalized, race-conscious treatment strategies.

This research was supported by a Clinical and Translational Science Award (UL1 TR001439) from the National Center for Advancing Translational Sciences at the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.