Ann. Medit. Burns Club - voL VI - n. I - March 1993

EPIDEMIOLOGY OF BURNS ACCORDING TO SEX STUDY IN A SPANISH REGIMAL BURN UNIT

Pardo L.

Centro cle Quemoclos Hospital General SX.S., Alicante, Spain

SUMMARY. Ever since man discovered fire, the treatment of burns has been die object of concern not only because of the high mortality but also because of the severe sequelae. Burns can be prevented only when the risk factors are fully known. Twenty-nine features were studied in the 265 patients hospitalized in the Alicante (Spain) Bums Unit in 1990-91, and the results were compared with those of other studies. The male/female ratio was 67.55% to 32.45%, a finding similar to that found in other countries (except Algeria, Kashmir and Jordan). No significant differences were found between the sexes except as regards marital status, causative agent, localization and occupation.

Some years ago Mir y Mir (1) observed that the treatment of bums has been the object of great concern ever since man discovered fire, in view of the high mortality and the severe sequelae.
In all American and European countries, the concern with burns is increasing. There are a great number of epidemiological studies about burns. Bouter et al. (2), in 1989, maintained that prevention of burns is only possible when the risk factors are known. A certain number of these factors can be modified, e.g. legislation.and health education, but not others (sex, age, socioeconomic status).
Hampton et al. (3), in 1988, reported that a high number of bums could be avoided. Most burns occurred at home during the performance of routine domestic duties.
The importance of the problem is shown by the number of studies. Although the various data are not wholly comparable, owing to different recording and measuring methods, severity criteria and systems of medical care, we will review a certain number of results.

The material was obtained from the case histories of the in-patients treated at the Burns Unit of the Hospital S.V.S., Alicante, from October 1989 to October 1991. This is the only Burns Unit in the province. We have 18 beds for children and adults. In 1989, 1.046 burned patients received emergency care (143 in-patients), and in 1990, 953 patients (121 inpatients). 27 patients were sent to Hospital La Fe (Valencia) in 1990, and 15 in 1991, owing to several circumstances.
In order to perform this work, a form with 50 items, including sex, was prepared and used in every in-patient. 7Wenty-nine of these items were studied in more detail. Two "health" interviews were also performed: the first on the arrival of the patient at the hospital, and the second three months after discharge.

Our study includes 265 burned patients requiring hospitalization, of whom 180 (67.55%) were males and 85 (32.45%) females (Fig. I and 2). The results are tabulated in six tables.

Pegg et al. (4), in 1978, found a sex ratio of 71.3% males to 28.7% females in a study on burns in Australia. The predominance of males in this case was probably due to the higher incidence of burns in industry in males. An article on bum injuries in a rural community of Virginia, published by Word et al. (5) in 1978, reported an incidence of 81% burns in males.  ROding (6) in a study on burns in the German Democratic Repubblic performed in 1978, reported that the malelfemale ratio was 2/1 in favour of males. There was an incidence of 4.4-5.6 per 10,000 males, and 2.4-2.9 per 10,000 females. In a study on burns in childhood in Australia, published in 1978 by Joseph et al. (7), 60.8% of cases concerned males and 39.2% females. Bouayad et al. (8), in work on bums in Algeria published in 1978, reported that the number of females was twice that of males: 65% and 35% respectively. The predominance of females was more evident in the 16 to 40 years age group. Waisbren et al. (9), in 1979, published a study on burns in Winsconsin over a 19-year period. They found that, of 184 in-patients, 140 were males and,44 were females, with a malelfemale ratio of 3/1. El-Muhtaseb et al. (11) published the results of a work on bums in Jordan, performed in 1981, showing a male/female ratio of 2/1. Glasheen et al. (12), in a study on minor burn injuries in Virginia published in 1982,. found that the number of males with minor burns was higher than the number of females, reaching 60.8%.
In the report on burns in Japan performed in 1982 by Yoshioka et al. (13), the malelfemale ratio was 3/1 (73% males 27% female). Most of the electric and sun bums occurred in females. In the study of the high-risk population for serious bum injuries performed by Glasheen et al. (14) in 1982, it was found that 1, 119 concerned males and 433 females. The white male was the most frequently affected (48.8%), followed by the black male (18.4%), the white female (17.1%) and the black female (9.1%). Mazla et al. (15), in 1982, published a study on burns in Kashmir, showing a malelfemale ratio of 1/1.4. Adult males accounted for 35%, male children 6%, adult females 49% and girls 10%. Sowemino (16) reported, in 1982 that the male/female burns ratio in Lagos was 3/2 in children and 3/1 in adults. In a work published in 1982 on children's burns due to cooking oils in Australia, Pegg et al. (17) found that 55% of cases concerned boys and 45% girls. This ratio is lower than that found by the same author in 1979 (5/2) and that found by Clark and Lerner (18) in 1978 (2/1). In the study performed in 1982, Pegg (17) found a higher proportion of females in the 30-39 years age group, a lower proportion of females in the over 60 years age group, a higher proportion of males in the 50-59 and the 20-29 years age groups, and a much lower proportion of males in the over 60 years group, compared to the same author's findings in 1979. In 1983, Pegg (19) reported that 20-year-old males are the most exposed to burns risk. The malelfemale was 1.8/1 (63.9% males and 36.1% females). There were no differences in the other types of accident. Ragheb et al. (20), in 1984, published a report about burn injuries in Jordan showing that the 59% occurred in females. The male/female ratio was 1/1.45 (1/1.65 in fire burns and 1.2/1 in hot water burns). Green (21), in 1984, reported that the incidence of bums in childhood in Wales was twice as high in males as in females (62.4% and 37.6%, respectively). Byrom et al. (22), in 1984, published a report on flame injuries in Virginia, showing that 74% occurred in males. In a study on childhood bums in Sussex conducted by Smith in 1984 (23), the number of males was almost twice that of females (128m). In the 10- 16 years group the ratio was 3/1 in favour of boys. Lyngdorf (24), in 1986, published an article on childhood scalds in Denmark showing that of the 131 patients aged 0-5 years 77 were boys and 54 girls. In the other age groups, there were no sex-related.differences.
In the report on childhood scalds in Australia published in 1986 by Phillips et al. (25), 57. 1 % were in males, and 42.9% females. In this study, the male/ female ratio was 1.4/1, which is significantly lower than in cases where other types of burns were considered, where the ratio was 2/1.
Hytonen et al. (26), in 1987, reported that 70% of bum injuries in Finland occurred in males. In Texas the malelfemale burns ratio was 1. 1/1, according to Bang's report (27) in 1988. In the study on burns in Qatar published by AlBaker et al. (28) in 1989, it was found that all the patients treated for car radiator burns were males, most of them in the 20-40 years age group. In 1990, Lindblad et al. (29) reported a ratio of girls1boys who suffered bum injuries in Denmark of 1/1.6. This finding is the same as that published by Lyngford in 1986. Conversely, in 1990, Daniel et al. (30) found that in Ethiopia 53.9% of burns occurred in females.
In 1990 Palumbo et al. (31) published a study on the New Jersey burn population, reporting that males represented 69%, of whom 58% were white. Refeffing to burn injuries in Greece, Panayotou (32) in 1991 found a higher incidence in males, except for children of less than one year and adults older than 60. The latter finding was perhaps due to the greater expectation of life in females. Rijn (33) in 1991, found that in the Netherlands males suffered severe bums more often than females. However, females were more often treated for minor bums in casualty departments. Scalds and contact inJuries occurred more often in females, while flame, electric and chemical bums were more frequent in males.
Mirabet et al. (34), in 1991, reported that 66% of burns registered in Valencia occurred in males, and that mortality was higher among males.

In our study, we included 265 patients with burns requiring hospitalization, of whom 180 were males (67.55%) and 85 females (32.45%). Our results are similar to those found in other countries, except for Algeria, Kashmir and Jordan, where burns were predominant among females.
We did not find any significant differences in relation to city size. Among males the 6-14 years age group was most affected. The incidence of bum injuries was higher in unmarried males and in married females. Occupational burns occurred more often in males. Fire was the most common agent in males, and scalds in females. As regards localization, the lower extremities were the most common in females. lliere were no significant differences in the other items investigated.

RESUME. Depuis la découverte du feu l'homme a cherché à traiter les brûlures Don seulement à cause de la mortalité élevée mais aussi des graves séquelles. Il est impossible de prévenir les brûlures si l'on ne connaît pas parfaitement les causes. L'auteur présente une analyse de 29 facteurs observés chez les 265 patients hositalisés à l'unité des brûlés d'Alicante (Espagne) pendant la période 1990-91, et les résultats sont comparés avec les résultats des autres enquêtes. Le rapport entre le sexe masculin et féminin était 67,55% contre 32,45%, un résultat comparable aux résultats observés dans les autres pays (excepté Algérie, Kashmir et Jordane). Pour ce qui concerne la situation de famille, l'étiologie, la localisation et la profession, il n'est pas possible de discerner des différences significatives.

1. Mir y Mir: "Fisiopatologia y tratainiento de las quemaduras y sus secuelas". Editorial cientifico-m6dica, Barcelona, 1969.
2. Bouter L.M., Knipschild P.G., van Rijn J.L.O., Meertens R.M.: How to study the aetiology of burn injury: the epidemiological approach. Bums, 15: 162-166, 1989.
3. Hampton K.K., Peatfield R.C., Puller T., Bodansky H., Walton C., Feely M.: Quemaduras a consecuencia de epilepsia. British Medical Journal, 3: 71-73, 1988.
4. Pegg S.P., Gregory J.J., Hogan P.G., Mottarelly I.W., Walker L.F.: Epidemiological pattern of adult bum injuries. Burns, 5: 326-334, 1978.
5. Word E.L., Meacher D.E., Beville C., Tewksbury C.G., Edlich R.F.: Epidemiology of burn injuries in a rural community. Burns, 5: 343-348, 1978.
6. Roding H.: The epidemiology of burn injuries in the German Democratic Republic. Burns, 5: 208, 1979.
7. Josep T.P., Douglas B.S.: Childhood burns in South Australia: a socio-economic and aetiological study. Burns, 5: 335-342, 1978.
8. Bouayad A.R., Benhamia A.: Epidemiology of burns in Algiers. Burns, 5: 204-205, 1978.
9. Waisbren B.A., Stem M., Collentine G.E.: Data for comparative study from a burns centre (1979). Burns, 5: 30-35, 1979.
10. Thompsen M., Bjorn L., Sorensen B.: Ile total number of burn injuries in a Scandinavian population: a repeated estimate. Burns, 5: 72, 1978.
11. El-Muhtaseb H., Qaryoute S., Raheb SA.: Bums injuries in Jordan: a study of 338 cases. Burns, 10: 116-120, 1984.
12. Glasheen P., Attinger E.P., Antharvedi A.: Epidemiology of minor burn injuries. Burns, 8: 423-432, 1982.
13. Yoshioka T, Ohashi H., Sugimoto H.: Epidemiological analysis of deaths caused by burns in Osaka, Japan. Burns, 8: 414, 1982.
14. Glasheen W.P., Attinger E.O., Haynes A.A.: Identification of the high-risk population for serious burn injuries. Bums, 9: 193, 1982.
15. Mazla C.N., Misgar M.S., Mehmooda K., Singh S.: Analytical study burns in Kashmir. Bums, 9: 180-183, 1982.
16. Soweminio G.O.: Burn injuries in Lagos. Burns, 9: 280-283, 1982.
17. Pegg S.P., Seawright A.: Burns due to cooking oils - an increasing hazard. Burns, 9: 362-SO9, 1982.
18. Clarke W.R., Lemer D.: Two years of hospitalized burned patients in Central New York. J. Trauma, 18: 524, 1978.
19. Pegg S.P., McDonald C.E., Tracey-Patte C.E., Mayze T.D.: Epidemiology of bums attending a casualty department in Brisbane. Bums, 9: 416-421, 1983.
20. Ragheb S.A., Qayoute S., EI-Muhtase H.: Mortality of bum in juries in Jordan. Burns, 10: 439-443, 1984.
21. Green A.R., Fairclough J., Sykes P.I.: Epidemiology of burns in childhood. Welsh Bums Centre. Bums, 10: 368, 1984.
22. Byrom R.R., Word E., Tewksbury C.G., Edlich R.F.: Epidemiology of flame bum injuries. Bums, 11: 1-10, 1984.
23. Smith R.W., O'Neill T.J.: An analysis into childhood burns. Burns 11: 117-124, 1984.
24. Lyngdorf R: Occupational burn injuries. Burns Incl. Therm. Inj., 13: 294-297, 1986.
25. Phillips W., Mahairas E., Hunt D., Pegg S.P.: The epidemiology of childhood scalds in Brisbane. Burns, 12:343-350, 1986.
26. Hytonen M., Honkanen R., Asko-SeIjavaara S.: Incidence of burns requiring hospitalization in Finland in 1980. Ann. Chir. Gynaecol., 76: 218-221, 1987.
27. Bang R.L., Mosbah K.M.: Epidemiology of burns in Kuwait. Bums Incl.'Therm. Irj., 14: 194-200, 1988.
28. Al-Baker A.A., Attalla M.F., EI-Ekiabi S.A., Ghoul A.: Car radiator burns: a report on 72 cases. Bums, 15: 265-267, 1989.
29. Lindblad B.E., Terkelsen C.L: Domestic bums among children. Burns, 16: 254-256, 1990.
30. Daniel E., Yoo M.C.: Survey of bum admissions to the EthioSwedish Children's Hospital. Ethio. Med. L, 28: 163-168, 1990.
31. Palumbo L., Budin W.C.: A descriptive summary of New Jersey's 1985 burn population. J. Bums Care Rehabil., ll: 565-572, 1990.
32. Panayotou R, Alexis D., Striglis C.H., Ioannovich L: Epidemiological data on burn injuries in Creece; a statistical evaluation. Bums, 17: 48-49, 1991.
33. Van Rijn LL.O., Bouter L.M., Meertens R.M.: The aetiology of burns in developed countries: review of the literature. Bums IS: 217, 1991.
34. Benito L, Navarro A., Baena R, Mirabet V: An analysis of burn mortality: a report from a Spanish regional burn centre. Bums, 17: 201-204, 1951.