This cohort study evaluates changes in characteristics of young aduts who carried handguns from 2019 to 2021.

Many actors have recently launched significant new initiatives in the domain of climate change and health. Given this important nexus, we undertook a review of funding patterns from 1985 – 2022, using the NIH RePORTER database for the United States and the Dimensions database globally. This includes an assessment of more than 9 million publicly funded projects across both databases with a collective budget of more than $3 trillion. We estimate that between 1985 and 2022 only 0.26% of research funding awarded by the NIH related to climate change, and only 0.70% of funded projects in the Dimensions database related to climate change and human health. Moreover, we thematically map funding patterns according to four thematic areas: changes in climate, the effects of climate change, health impacts, and interventions and strategies. More funding is needed to better anticipate and prepare for the projected health impacts of climate change.

Background: Few epidemiologic studies have examined the association of ambient heat with spontaneous abortion, a common and devastating pregnancy outcome. Methods: We conducted a case-crossover study nested within Pregnancy Study Online, a preconception cohort study (2013-2022). We included all participants reporting spontaneous abortion (N = 1,524). We defined the case window as the 7 days preceding the event and used time-stratified referent selection to select control windows matched on calendar month and day of week. Within each 7-day case and control window, we measured the mean, maximum, and minimum of daily maximum outdoor air temperatures. We fit splines to examine nonlinear relationships across the entire year and conditional logistic regression to estimate odds ratios (ORs) and 95% confidence interval (CI) of spontaneous abortion with increases in temperature during the warm season (May-September) and decreases during the cool season (November-March). Results: We found evidence of a U-shaped association between outdoor air temperature and spontaneous abortion risk based on year-round data. When restricting to warm season events (n = 657), the OR for a 10-percentile increase in the mean of lag 0-6 daily maximum temperatures was 1.1 (95% CI: 0.96, 1.2) and, for the maximum, 1.1 (95% CI: 0.99, 1.2). The OR associated with any extreme heat days (>95th county-specific percentile) in the preceding week was 1.2 (95% CI: 0.95, 1.5). Among cool season events (n = 615), there was no appreciable association between lower temperatures and spontaneous abortion risk. Conclusion: Our study provides evidence of an association between high outdoor temperatures and the incidence of spontaneous abortion.

Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts.

Purpose To describe the intermediate-term incidence of hypertension following pediatric renal trauma relative to that in an extremity (control group) trauma cohort. Methods This was a single-institution matched cohort study of pediatric patients presenting to a Level I trauma center between 2010 and 2019. The primary cohort included patients who sustained renal trauma, and a comparator cohort of sex- and age-matched patients with isolated extremity fracture was identified. The primary outcome was new hypertension, and a sensitivity analysis was conducted of any elevated blood pressure (EBP). Conditional logistic regression was performed and adjusted for overweight/obese status. Results There were 62 renal trauma patients included, representing 35% of all eligible patients seen in the study period. Hypertension was not found to be more prevalent with renal trauma (OR 1.18, 95% CI: 0.41, 3.39). The incidence of hypertension (9.7-11.3%) and EBP (22.6-32.3%) was comparable between renal trauma and control groups. Conclusion Despite a high incidence of EBP and hypertension in pediatric patients after renal or extremity trauma, we did not observe an association between renal trauma and postinjury hypertension. We identified no cases of malignant or symptomatic hypertension, and no surgical interventions for renovascular hypertension was performed. Our findings suggest that only select patients, rather than most renal trauma patients, may benefit from monitoring for postinjury hypertension.

BACKGROUND:Extreme ambient heat is unambiguously associated with a higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured subpopulation are generalizable to the broader population has, to our knowledge, not been documented. We sought to address this question, for the US population in California from 2012 to 2019. METHODS:We examined changes in daily rates of emergency department encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source of health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information. We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5th percentile and used a space-time-stratified case-crossover design to assess and compare the impacts of heat on health. RESULTS:Average incidence rates of medical encounters differed by dataset. However, rate ratios for emergency department encounters were similar across datasets for all causes [ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.969, 1.009], heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar. CONCLUSIONS:This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case–control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95

BACKGROUND:Participant recruitment is a central aspect of human sciences research. Barriers to participant recruitment can be categorised into participant, recruiter and institutional factors. Firearm injury research poses unique barriers to recruitment. This is especially true for rural adolescents, who are at high risk for firearm-related injury and death, and whose voice is often absent in firearms research. In particular, recruitment strategies targeting adolescents should align with developmental changes occurring during this life stage. Identifying strategies to address recruitment barriers tailored to firearm-related research can help future researchers engage rural adolescents in injury prevention efforts. PURPOSE:The purpose of the current methodology paper is to outline barriers and provide strategies for recruiting rural adolescents in firearms research informed by the Youth Experiences in Rural Washington: Research on Firearm Safety project, a mixed-methods, community-based participatory research study of 13-18 year-olds residing in rural Washington. STRATEGIES:Recruitment barriers and related strategies were organised by participant-related and recruiter-related/institutional-related factors. While carrying out the study, key considerations or strategies which addressed multiple participant and recruiter/institutional factors, emerged with potential to enhance firearm-related research with rural adolescents more broadly. Key considerations included logistics (ie, scheduling flexibility, adequate and aligned incentives), use of a community-based participatory research approach and accounting for developmental stage. CONCLUSION:Reducing the burden of firearm injury and death for rural adolescents and developing effective interventions requires understanding and navigating recruitment barriers. Strategies used in the current project can guide future qualitative or mixed methods data collection informing firearm injury prevention.

ImportanceRural adolescents are at high risk for firearm-related injury, yet most existing prevention efforts are informed by research conducted in urban areas. Despite the need to account for rural perspectives, few studies have investigated the unique social ecological context of firearms for rural adolescents or have directly engaged with rural adolescents to understand their views on firearm use.ObjectiveTo describe rural adolescents’ firearm behaviors and perceptions of firearm-related social norms within their communities, peer groups, and families.Design, Setting, and ParticipantsThis cross-sectional study used a convergent mixed-methods design and involved a community-based participatory research approach. Participants comprised 93 adolescents residing in rural Washington state and enrolled in a county or tribal reservation 4-H youth development program as an intermediate or senior age-level grouping (ie, aged 12-19 years). Adolescents completed a survey and participated in a semistructured focus group or interview between September 1, 2021, and September 30, 2022. Data were analyzed using descriptive and thematic analysis.Main Outcomes and MeasuresIndividual handgun behavior and peer, family, and community perceptions of firearm-related social norms.ResultsThe sample included 93 adolescents (mean [SD] age, 15.7 [1.7] years; 49 female participants [52.7%]). Approximately half of participants (52 [55.9%]) had carried a handgun at some point in their lives, with a mean (SD) age at first carry of 10.9 (3.1) years. Primary themes across quantitative and qualitative data focused on social norms (specifically, acceptable and unacceptable ways to engage with firearms, reasons for carrying firearms, and places to carry a firearm).Conclusions and RelevanceIn this cross-sectional study, rural adolescents in 4-H programs generally understood acceptable and unacceptable firearm carrying behaviors, which aligned with state laws. Findings provide context for rural adolescent behaviors such as carrying a firearm predominantly for prosocial reasons (hunting, recreation, and sport) and adult behavior such as carrying for protection of person and personal property. Understanding firearm-related social norms in rural communities holds implications for firearm injury prevention efforts, especially related to enhancing training, developing norms-based prevention approaches, and tailoring efforts to rural settings.

PURPOSE:Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm-related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults.METHODS:We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past-month alcohol use on handgun carrying in the subsequent 12 months using population-average generalized estimating equations with logistic regression on multiply imputed data.FINDINGS:During adolescence (ages 12-18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19-26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence.CONCLUSIONS:Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm-related harm among young people in rural areas.

INTRODUCTION:Depressive symptoms are associated with higher risk of dementia but how they impact cognition in diverse populations is unclear.METHODS:Asian, Black, LatinX, or White participants (n=2,227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over four years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity.RESULTS:Higher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95%CI: -0.12, -0.01; -0.15, 95%CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95%CI: -0.07, -0.01; -0.10, 95%CI: -0.15, -0.05) for Black and LatinX participants. Depressive symptoms were associated with lower baseline but not decline in executive function.DISCUSSION:Depressive symptoms were associated with worse cognitive domains, with some evidence of heterogeneity across racial/ethnic groups.

BACKGROUND:Over 120 million people in the USA live in areas with unsafe ozone (O3) levels. Studies among adults have linked exposure to worse lung function and higher risk of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have examined the effects of O3 in children, and existing studies are limited in terms of their geographic scope or outcomes considered. METHODS:We leveraged a dataset of encounters at 42 US children's hospitals from 2004-2015. We used a one-stage case-crossover design to quantify the association between daily maximum 8-hour O3 in the county in which the hospital is located and risk of emergency department (ED) visits for any cause and for respiratory disorders, asthma, respiratory infections, allergies and ear disorders. RESULTS:Approximately 28 million visits were available during this period. Per 10 ppb increase, warm-season (May through September) O3 levels over the past three days were associated with higher risk of ED visits for all causes (risk ratio [RR]: 0.3% [95% confidence interval (CI): 0.2%, 0.4%]), allergies (4.1% [2.5%, 5.7%]), ear disorders (0.8% [0.3%, 1.3%]) and asthma (1.3% [0.8%, 1.9%]). When restricting to levels below the current regulatory standard (70 ppb), O3 was still associated with risk of ED visits for all-cause, allergies, ear disorders and asthma. Stratified analyses suggest that the risk of O3-related all-cause ED visits may be higher in older children. CONCLUSIONS:Results from this national study extend prior research on the impacts of daily O3 on children's health and reinforce the presence of important adverse health impacts even at levels below the current regulatory standard in the USA.

This article introduces Bayesian spatial smoothing models for disease mapping-a specific application of small area estimation where the full universe of data is known-to a wider audience of public health professionals using firearm suicide as a motivating example. Besag, York, and Molli & eacute; (BYM) Poisson spatial and space-time smoothing models were fitted to firearm suicide counts for the years 2014-2018. County raw death rates in 2018 ranged from 0 to 24.81 deaths per 10 000 people. However, the highest mortality rate was highly unstable, based on only 2 deaths in a population of approximately 800, and 80.5% of contiguous US counties experienced fewer than 10 firearm suicide deaths and were thus suppressed. Spatially smoothed county firearm suicide mortality estimates ranged from 0.06 to 4.05 deaths per 10 000 people and could be reported for all counties. The space-time smoothing model produced similar estimates with narrower credible intervals as it allowed counties to gain precision from adjacent neighbors and their own counts in adjacent years. Bayesian spatial smoothing methods are a useful tool for evaluating spatial health disparities in small geographies where small numbers can result in highly variable rate estimates, and new estimation techniques in R software have made fitting these models more accessible to researchers.

Extreme risk protection orders (ERPOs), which allow for the temporary restriction of firearm access for individuals at substantial risk of harming themselves and/or others, are a promising policy tool to address increasing rates of firearm-related suicide, homicide, and mass shootings. Social workers frequently assess clients at risk of firearm-related harm, positioning social workers to play a key role in ERPO implementation. This study sought to understand social workers' perspectives on ERPOs. Authors invited 6,910 licensed social workers in Washington state to participate in a survey in May and June of 2021 about facilitators and barriers to their willingness to counsel clients' family members, contact law enforcement, or independently file ERPOs for clients at risk of harm to self (HTS) or others (HTO). Of the 1,381 survey participants, most were willing to counsel (96 percent for HTS; 96 percent HTO), contact law enforcement (84 percent for HTS; 87 percent for HTO), or independently file an ERPO (78 percent for HTS; 79 percent for HTO). Common barriers associated with willingness were lack of understanding about the ERPO process and concerns with involving the legal system/law enforcement. Key facilitators included training social workers about ERPOs and availability of legal experts for consultations. Social workers are willing to incorporate ERPOs into their practice for clients, but remaining barriers need to be addressed to support the practice.

BACKGROUND Little is known about the recovery experiences of older trauma intensive care unit (TICU) survivors and the relationship between geriatric trauma care and long-term functional ability and health-related quality of life (HRQOL). METHODS We conducted a prospective cohort study of 218 patients (age, ≥65 years) admitted to a Level 1 regional trauma center TICU before versus after implementation of a geriatric care bundle with protocolized geriatrics consultations (Geri-T). Survivors or their proxies were interviewed approximately 1 year after hospitalization. Outcomes included the Katz Index of Independence in Activities of Daily Living (ADLs), Lawton Instrumental Activities of Daily Living (IADLs), and EQ-5D-5L HRQOL survey. Two investigator-developed questions regarding recovery experiences were included. Differences in outcomes among survivors admitted before versus after Geri-T were analyzed using multivariable linear regression. Responses to questions about recovery experiences were qualitatively assessed using content analysis. RESULTS We reached 67% (146/218) of hospital survivors or their proxies across both groups; 126 patients were still alive and completed the survey. Mean age was 76 (SD, 8), 36% were female, and 90% were independent with ADLs preinjury. At follow-up, independence with ADLs was 76% and IADLs was 63%. The mean EQ-5D-5L index score was 0.78 (SD, 0.18). Most patients (65%) reported having not returned to preinjury functional status. Neither functional ability or HRQOL differed significantly among patients admitted before versus after Geri-T. Content analysis of open-ended questions revealed themes of activity limitations, persistent pain, and cognitive dysfunction. CONCLUSION Nearly one-fifth of TICU survivors experienced loss of ADL function 1 year after injury, and most reported having not returned to preinjury functional status. Nonetheless, patient-reported HRQOL was comparable to age-adjusted norms. Geri-T was not associated with differences in HRQOL or functional ability. Survivors reported persistent difficulty with activities beyond those of daily living, pain, and cognition. LEVEL OF EVIDENCE Prognostic and Epidemiologic, Level III.

Background:Evidence for acupuncture to treat pain is growing. Electrostimulation of acupuncture needles (electroacupuncture) is common for pain and is thought to augment the therapeutic effect.Objectives:To examine the association of pain outcomes after a single acupuncture session with electrostimulation included (EA) compared with no electrostimulation included (NEA).Methods:A retrospective observational study was conducted using electronic health records of acupuncture sessions for adults with acute pain under the care of an acute pain service. Paired t-test and linear regression were used to report pain intensity changes after a single acupuncture session and by including EA. Ordered logistic regression was used to report categorical pain relief. Logistic regression was used to explore the odds of adding EA and the patient's age, gender, and pretreatment pain.Results:From July 24, 2017, through November 9, 2020, 465 acupuncture sessions recorded EA (n = 194), or NEA (n = 271). Acupuncture, independent of EA status, reduced pain intensity by a mean 2.5 points. EA was associated with a mean 0.38-point reduction in pain intensity more than NEA (confidence interval [95% CI]: -0.75 to -0.01). Among sessions reporting categorical pain relief (n = 415), higher relief was more likely with EA (odds ratio = 2.16, 95% CI: 1.52-3.08). There was no association between EA and the patient's age, gender, and pretreatment pain intensity.Conclusions:After a single acupuncture session, both EA and NEA reduced pain intensity. Higher categorical pain relief was reported with EA, though the clinical meaning is uncertain. Future research should focus on well-defined populations for electroacupuncture and factors for including electrostimulation.

OBJECTIVES:This study builds on prior research showing a strong relationship between handgun carrying and delinquent behaviors among urban youth by examining the association between handgun carrying trajectories and various types of violence in a rural sample.METHODS:This study uses data from a longitudinal cohort study of 2002 public school students in the United States from 12 rural communities across 7 states from ages 12-26 (2005-2019). We used logistic regressions to assess associations of various bullying and physical violence behaviors with latent trajectories of handgun carrying from adolescence through young adulthood.RESULTS:Compared to youth with very low probabilities of carrying a handgun in adolescence and young adulthood, trajectories with high probabilities of handgun carrying during adolescence or young adulthood were associated with greater odds of using bullying (odds ratios (ORs) ranging from 1.9 to 11.2) and higher odds of using physical violence during adolescence (ORs ranging from 1.5 to 15.9) and young adulthood (ORs ranging from 1.9 to 4.7). These trajectories with higher probabilities of handgun carrying were also associated with greater odds of experiencing physical violence like parental physical abuse and intimate partner violence, but not bullying.CONCLUSION AND IMPLICATION:Experiencing and using bullying and physical violence were associated with specific patterns of handgun carrying among youth growing up in rural areas. Handgun carrying could be an important focus of violence prevention programs among those youth.

Importance Adolescent handgun carrying is associated with increased risk of firearm-related violence. Most evidence on adolescent handgun carrying is from urban areas, but these findings may not generalize to rural areas.Objective To examine differences in associations of adolescent interpersonal violence with handgun carrying across the rural-urban continuum.Design, Setting, and Participants This cross-sectional study used nationally representative data from the US National Survey on Drug Use and Health among adolescents aged 12 to 17 years from 2002 to 2019 to estimate time-varying prevalence ratios (PRs) and prevalence differences (PDs) between interpersonal violence and handgun carrying across the rural-urban continuum. Analyses were conducted in April to July 2022.Exposures Any past-year serious fighting, group fighting, and attacking with intent to harm.Main Outcomes and MeasuresAny past-year handgun carrying. Associations were estimated within county rural-urban strata using the US Department of Agriculture's Rural-Urban Continuum Codes.Results In each year, the sample included a weighted count of almost 25 million adolescents, with 50.9% (95% CI, 50.2%-51.6%) males and 24.7% (95% CI, 23.8%-25.6%) Hispanic adolescents, 13.5% (95% CI, 12.8%-14.2%) non-Hispanic Black adolescents, and 51.8% (95% CI, 50.8%-52.8%) non-Hispanic White adolescents in 2019. More rural counties had less racial and ethnic diversity. For example, 81.1% (95% CI, 75.9%-85.4%) of adolescents were non-Hispanic White in the most rural counties vs 43.1% (95% CI, 41.7%-44.6%) of adolescents were non-Hispanic White in the most urban counties in 2019. Adolescent handgun carrying increased over time, with the largest increases in the most rural counties, where the prevalence of adolescent handgun carrying increased from 5.2% (95% CI, 3.8%-7.0%) in 2003 to 12.4% (95% CI, 8.9%-16.9%) in 2019. PRs for the association of violence and handgun carrying were greater in more urban counties. For example, in the most urban counties in 2019, adolescents involved in a group fight had 3.7 (95% CI, 2.9-4.8) times the prevalence of handgun carrying vs those not involved in a group fight; this PR was 3.1 (95% CI, 1.6-5.6) in the most rural counties. PDs were similar and, in some cases, larger in rural areas. For example, in the most urban counties in 2019, handgun carrying prevalence was 7.5% (95% CI, 5.7%-9.5%) higher among adolescents who were involved in a group fight compared with those who were not; this PD was 21.8% (95% CI, 8.2%-37.8%) in the most rural counties, where handgun carrying was more common.Conclusions and Relevance This cross-sectional study found that associations of interpersonal violence with handgun carrying were stronger in relative terms in urban areas than in rural areas; however, a higher percentage of rural than urban adolescents carried handguns, resulting in a greater absolute prevalence of handgun carrying associated with violence in rural areas than in urban areas. These findings suggest opportunities for preventing handgun carrying-related harms may differ between rural and urban communities.

Introduction: To optimize the early care of burned patients, protocols were developed that guide pre-hospital care and the need to transfer to a specialized burn treatment unit. Burn disasters are an important public health concern in developed and developing nations. Among the early steps in disaster preparedness is the understanding of geographic locations and capacity of burn care facilities. We aimed to map and classify medical facilities that provide burn care in Brazil and to undertake a location-allocation analysis to identify which could be targeted to increase capacity. Methods: A review of burn hospitalizations was conducted using Brazilian Ministry of Health data. Capacity was defined by number of burn patients admitted each year and bed type. Spatial population data per one-square kilometer were obtained from World Pop as a raster dataset. A road network dataset using Open Street Map data was created to conduct the drive time analysis. Location/allocation analysis was conducted to identify the proportion of Brazil's population living within 2- and 6-hours' drive time of a burn care capable hospital, stratified by the level of hospital capacity. Hospitals were ranked according to number of additional people served. Results: We found 26.471 burn admissions. Of these, 3.508(13,2 %) were ICU admissions. A total of 735(2,7 %) hospital deaths occurred under the selected burn codes. In all, 1.273 facilities admitted burn patients, and 263(20,7 %) reported ICU admissions of burn patients. Seventeen hospitals were classified as maximum capacity facilities. Additional 23 hospitals were identified as potential targets for capacity building. Most maximum capacity hospitals are clustered in the Southeast of Brazil. Currently, 40.8 % of the Brazilian population live within 2 h of a maximum capacity facility. A large part of the population lives farther than 6 h away from a maximum capacity hospital. Most of the potential targets for capacity building are located near the coast of Brazil. Discussion: We mapped and classified facilities that provide public burn care in Brazil. We identified public facilities that could be targeted to increase capacity to improve access for patients in the event of a burn disaster. Mapping, planning, and coordinating response is key for optimal outcomes in Mass Casualties Incidents. Cataloging and understanding local resources is a crucial first step in disaster management. Inequality in profiles can determine specific regional needs. Specialized burn centers are rare in regions other than the southeast. Health equity should be considered when planning disaster preparedness