The tale of two states: mortality outcomes and burn severity among in-state versus out-of-state burn victims treated in the Texas Panhandle

Background: Geographic disparities in healthcare access may influence outcomes following burn injury. This study evaluated whether state of residence was associated with in-hospital mortality among burn patients treated at a regional American Burn Association–verified burn center in the Texas Panhandle and examined the effect of burn severity on survival. Methods: A retrospective cohort study was conducted of 2017 adult burn patients treated between 2019 and 2024. Patients were categorized by state of residence (Texas vs New Mexico). Multivariable logistic regression identified independent predictors of mortality, adjusting for comorbidities, total body surface area (TBSA) burned, length of stay, and intensive care unit days. A secondary model evaluated the association between second- and third-degree burn percentages and survival. Results: Mortality was higher among New Mexico patients than Texas patients (10.67% vs 4.26%; P < 0.001). However, state of residence was not independently associated with burn mortality in the overall cohort after adjusting for distance to treatment and injury severity, although subgroup analysis of lower-severity burns demonstrated persistent differences. Among patients with TBSA ≤30% (n = 1917), mortality was higher in New Mexico than Texas (6.91% vs 2.84%; P < 0.001), and state of residence remained an independent predictor after adjustment (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.03–3.18). Distance to definitive burn care also demonstrated a significant trend toward increased mortality (OR 1.003 per mile; 95% CI 1.001–1.005; P = 0.02), while burn severity and comorbidity burden remained significant predictors. Conclusions: State of residence was not independently associated with burn mortality in this cohort after adjusting for distance to treatment and injury severity. These findings highlight geographic disparities and support consideration of system-level interventions.