Characterization of stigma and its predictors in the burn population: A Burn Model System National Database study

Stigma is prejudice and discrimination resulting from negative stereotypes. Burn survivors have greater risk for stigmatization, potentially influencing quality of life. This study aims to characterize stigma and its predictors in the burn population. Adult burn survivors enrolled in a multicenter longitudinal database from 2015-2024 were examined. The primary outcome was the self-reported Neuro-QoL Stigma scale assessed at 6-, 12-, 24-, and 60-months post-injury. At 6-months post-injury, the range of stigma scores was calculated. Stigma scores were calculated at all timepoints, and linear mixed-effects models determined significant changes in stigma over time. Linear mixed-effects models with random effects assessed sociodemographic and clinical variables associated with stigma scores over time (total t-score and item-level scores with separate models). 787 adult burn survivors were included. Most participants were male (68.1%), white (78.8%), and not of Hispanic/Latino origin (75.0%). The median burn size was 10% and 74.7% had visible burn injury locations. At 6-month post-injury, the distribution of stigma scores was a bell-shaped curve with a slight right skew. The mean Neuro-QoL Stigma score at 6-months post-burn injury was 49.3 (clinical reference population=50). Stigma scores remained unchanged over time (p=0.66). Younger-aged adulthood, non-white race, larger burn size, and substance use were associated with higher stigma summary scores (p<0.05). Stigma is relevant in the burn population and remains unchanged over time after burn injury. Age, race, burn size, and substance use are predictors of stigma over time. Clinicians can identify burn survivors with stigma and provide tailored resources and community-based assistance.