Introduction

The Brazilian Burn Society (SBQ, from Sociedade Brasileira de Queimaduras) defines a burn as any injury resulting from direct contact with hot or cold substances, whether chemi-cally active, electrically charged, or radioactive. The SBQ also considers venomous animals or stinging plants as causes of burns. In some cases, this injury elicits a potent inflammato-ry reaction, which may trigger a dangerous systemic re-sponse when a burn affects at least 30% of the body due to the release of cytokines and other inflammatory mediators.¹

The World Health Organization (WHO) reports that burns kill an average of 180,000 people worldwide each year. The causes of injury vary among different populations, but trauma remains a fundamental epidemiological compo-nent,² with 11 million burn victims requiring specialized care globally per year.² This figure exceeds the recorded incidence of tuberculosis and human immunodeficiency virus (HIV).³

Brazil witnesses, on average, 1,000,000 accidents per year, with 100,000 patients seeking hospital care, and around 2,500 cases resulting in death.^3,4 According to the Depart-ment of Informatics of the Brazilian Unified Health System (DATASUS) and SBQ, heat exposure resulting in burns gen-erates costs of approximately R$ 1,200.00 to 1,500.00 per day of hospitalization,⁴ amounting to a significant expenditure on the Brazilian public health system (SUS). In 2000, for instance, of all SUS hospitalizations, 3.39% (n = 23,550) were of burn victims.⁴ In 2023, burns affected 6,981 children and adolescents, with an average of 20 hospitalizations regis-tered per day, according to the Brazilian Ministry of Health. Scientific literature shows that burns mostly affects males, with alcoholism being the chief cause at all ages, except for the age group from 0 to 4 years old, in which scalding is the most common etiological agent, originating from the domestic kitchen environment.⁵ Theoretical bases also confirm that the mean age of burn victims ranges from 25 to 26 years, with a high number of first-degree burns alone, as well as a significant number of combined first-and second-degree burns.⁵

Other academic findings reveal that the average length of hospital stay for burn victims ranges from 1 to 2 weeks, and 51.5% of cases recorded in databases result from domestic accidents, with hot liquids as the most common cause. Fur-thermore, there is a low rate for attempted suicide (4.95%).⁶

As such, epidemiological studies are fundamental to establishing guidelines for healthcare practices and health promotion actions (such as university extension campaigns for burn prevention and projects improving treatment effec-tiveness for burn victims).⁷ For these reasons, and consider-ing the scarcity of epidemiological research on this topic in the state of Ceará, Brazil, this study is essential for outlining the epidemiological profile of burn victims in this region for a period of approximately 9 years.

Objectives

This study aimed to present data on the profile of burn victims in the state of Ceará, Brazil, and their epidemiology, aiming to inform projects to combat this adverse scenario. Moreover, it aimed to address research gaps in this subject within the state.

Materials and Methods

This ecological study collected data from 2015 to the first semester of 2024 from the virtual environment of the DATA-SUS,⁸ using the “Health Information” section.

Data selection on this platform focused on the topics “Epidemiology and Morbidity” and “Hospital Mobility (SUS)”. Initially, “Hospital Morbidity (SUS) - General, by place of admission, from 2008 onwards” was preferred. The data refer to all burn victims in the state of Ceará with recorded hospital care during this period. There were no exclusion criteria.

Individual characteristics, such as sex, age group, and skin color/ethnicity, were added as variables. Next, the diagnosis “burns and corrosions” was selected in the “International Classification of Diseases (ICD)-10 morbidity list” filter. Furthermore, information on the healthcare system (public or private), the notification region, and the type of healthcare provided was researched.

We compared some factors, including sex and age group, sex and skin color/ethnicity, and sex and urgent care. We categorized the patients into five age groups: infants (< 1-year-old), children (1-9-years-old), adolescents (10-19-years-old), adults (20-59-years-old), and seniors (> 60-years-old). We organized the data on Google Sheets (Google LLC.) and presented the results as absolute and relative figures using descriptive statistics.

Since this study utilized secondary data available in the public domain, it posed no risk to patient confidentiality and anonymity. Thus, it did not require approval from the Re-search Ethics Committee of the Universidade Estadual do Ceará.

Results

This study analyzed 7,892 burn victims from the state of Ceará in the period from 2015 to the first semester of 2024. We stratified the population per skin color/ethnicity, sex, age group, healthcare system (public or private), urgency of care, and notification region year by year (►Table 1).

Table 1 - Epidemiology of burn notifications in the state of Ceará, Brazil, from January 2015 to June 2024

Thus, we could determine that, in Ceará, burns were more predominant in male subjects, accounting for approximately 66.7% of notifications. Regarding the age group, the number of hospitalizations was higher in adults (20-59-years-old), with approximately 58% (n = 4,583) of notifications, fol-lowed by children (1-9-years-old), with around 20% (n = 1,595) of notifications. It is worth highlighting that subjects aged 1 to 4 accounted for 1,112 notifications, representing approximately 70% of the cases among children (►Table 1).

Moreover, approximately 87% (6,855) of notifications required emergency care. Most of the registered cases re-ceived treatment in SUS (►Table 2).

Table 2 - Data on the healthcare system and type attending burn victims in the state of Ceará, Brazil

We compared several variables to perform a specific analysis of the population. These comparisons included sex and age group, sex and skin color/ethnicity, sex and health-care system, as well as sex and type of healthcare provided (►Table 3). The analysis revealed a predominance of adult, Brown, male subjects, with a higher prevalence of emergency notifications in the public sector.

Table 3 - Epidemiological data in males and females

Discussion

The literature reveals that males account for most burn cases in Brazil.⁹ This also occurs in Ceará, where more than 70% of burns affected male subjects in our analysis. From this perspective, the injuries suffered by this group likely stem from high-risk work, which increases the likelihood of accidents, in this case, burn injuries.

Regarding age group, the results indicate that adults (20-59-years-old) account for the majority of notifications. The existing literature corroborates this trend,⁸ thus placing Ceará as a significant element in the statistics showing that adult men account for the most burn notifications in the country. This finding highlights the importance of prioritizing educational projects focused on adult males.

The fact that most notifications occur in people from 20 to 59-years-old is worrisome, as this demographic represents the economically active portion of the population.^9,10 The impact on the Brazilian economy also results from the mean daily expenditure of R$ 1,350 on burn victims¹⁰ who spend, on average, 7 days in the hospital.⁴ As such, each hospitalized burn patient incurs a cost of R$ 9,450, significantly impacting SUS.⁹

In a descriptive study, Santos et al. reported that most accidents referred to a tertiary hospital in Fortaleza originate from the work environment, with a predominance of first-and second-degree burns.¹¹

Regarding children in this cohort, the literature shows that most subjects were 0 to 3-years-old.^12,13 In Ceará, DATASUS revealed that the age group most affected by these injuries is 1 to 4 years old. This finding represents a warning for the state, as studies reported that the sequelae of burns consistently affect quality of life,¹⁴ influencing their body image.¹⁴ These outcomes can be worse in children due to their developmental compromise.^12-14

The literature on children suffering from burn injuries in Ceará is scarce. In an observational study, Secundo et al. reported that second-degree burns were the most common among children.¹⁵ Furthermore, reports indicated that areas such as the head, neck, trunk, and upper limbs are the most affected by burns in this age group.^15,16

Our results are consistent with the literature that indi-cates that most burn victims are Brown.^11,16 Thus, we determined a profile fitting the majority of the Ceará popu-lation, that is, male Brown adults. This profiling is essential for referencing projects on the reality of burn injuries in Ceará. Additionally, it can assist in decision-making for the intended audiences of various health education programs.

Regarding the healthcare system and type of healthcare provided, our data revealed that emergency care is more frequent in the public sector. This result was expected, given that 80% of Brazilians use SUS hospitals, according to the Ministry of Health. Urgent care for burns was also expected,¹⁷ given the treatment protocol, particularly for secondand third-degree injuries.^17,18

In our study, a limitation was the cases ignored by the DATASUS system, which reduced the numbers related to the healthcare system in Brazil, as confirmed by the research results.

As for the notification regions in Ceará, the greater Fortaleza area accounted for the majority of cases. This result was also expected, as the 2022 census revealed that this region has the largest population in the state. The second and third regions with the highest number of notifications were Sobral and Cariri, which present the largest populations after Fortaleza. These two regions had a minimal difference in case numbers and can be considered virtually equal. However, Fortaleza had a significant number of reports, approximately 88%.

As discussed throughout this article, data clearly demon-strated that Brown men aged 20 to 59-years, SUS users, and from the greater Fortaleza area are the primary victims of burn reports in Ceará. This observation highlights the spe-cific target population for future action and education proj-ects aimed at stemming this adverse situation. This study is innovative due to the scarcity of research on this topic in Ceará, focusing on profiling the burn population. Therefore, the government and the state’s universities must seek sol-utions to improve this scenario.

Another point worth highlighting is the care for subjects aged 1 to 4 in the state, as the number of notifications involving them deserves attention. We also suggest and the promoting campaigns to stop and reduce cases in this age group, which, according to the data, is the most affected by burns among children in Ceará.

Conclusion

Our results showed that most burn patients in Ceará are Brown men, 20 to 59-years-old, corroborating the need for local authorities to address this issue. Also, an age group outside the majority of cases requires further evaluation.

The present study thus enriches the scientific community, filling a gap in articles addressing this topic and scope in the state of Ceará. Furthermore, it highlighted the need for programs and projects promoting health, to mitigate this situation.