5 Examining ‘Return to Productivity’ Among People Living with Burn Injury: A Burn Model System National Database Report

Introduction Burn injuries can be life-altering events that involve intensive healthcare, changes in body image, psychological stress and financial toxicity. Burn survivors frequently experience numerous and varied barriers to returning to work. For those who return to work, little is known regarding whether they achieve pre-injury productivity (i.e., equivalent work output and/or pay). Understanding return to productivity and patients at risk of not achieving pre-injury productivity is important for targeting services that support this population and their families. Methods Burn survivors with complete occupational and personal income data through 24 months post-injury were extracted from the NIDILRR Burn Model System National Database. Participant annual income was reported in six groups: < $25k, $25k-50k, $50k-99k, $100k-149k, $150k-199k, $ >199k. Participants were classified by their change in income at each follow up (i.e., gain, loss, equivalent). Explanatory variables of interest included demographics, payer, job type, and injury characteristics. Logistic regression modeled return to productivity (i.e., equivalent or gain in income compared to pre-injury status) at each follow up interval. Results Data from 402 participants were analyzed. At 6-, 12-, and 24-months post-injury, 77%, 79%, and 71% of participants reported equivalent or gain in income, respectively. Physical and labor-based jobs were reported by 60% of participants who had return to productivity versus 63% of those who lost income. Demographics, payer, and job type were not significantly associated with differences in return to productivity. Mean %TBSA burn size was 17.4% in those who returned to productivity versus 26.1% among those who did not. Burn size ≥50% TBSA was the only predictor of decreased likelihood for return to productivity (OR 0.24, 95%CI 0.06–0.90). Post hoc comparison to participants who did not have complete financial data demonstrated that participants with complete data were significantly more likely to be older, white, have smaller burns, and carry private insurance. Conclusions Most burn survivors returned to pre-injury productivity by 24-months after injury regardless of demographics, job type, and payer status. Burn survivors who experienced ≥50% TBSA burns were much more likely to not return to pre-injury productivity.