Substance use, poverty, race predictive of orbital, facial fractures

Social determinants of health (SDOH) are significantly associated with maxillofacial trauma, suggests a US study. These SDOH factors include substance use, unhoused status, and poverty, among others.

A total of 5,796 patients with orbital fractures, facial fractures, or combination thereof and 23,184 control participants in the All of Us research program were included in this cross-sectional, population-based study. A retrospective analysis was carried out using electronic health records and survey data form All of Us.

The researchers explored the associations between SDOH factors and maxillofacial trauma via univariate t test and chi-square and multivariable logistic regression. They also assessed unmeasured confounding.

The following demographic factors correlated with maxillofacial trauma: male gender (odds ratio [HR], 2.09, 95 percent confidence interval [CI], 1.99‒2.21; p<0.001), American Indian race (OR, 3.08, 95 percent CI, 2.68‒3.53; p<0.001), and Black race (OR, 1.53, 95 percent CI, 1.44‒1.64; p<0.001).

Lifestyle factors associated with maxillofacial trauma included alcohol use (≥10 drinks daily: OR, 4.59, 95 percent CI, 3.76‒5.6; p<0.001), cigarette smoking (OR, 2.18, 95 percent CI, 2.05‒2.31; p<0.001), and street opioids (OR, 3.53, 95 percent CI, 3.09‒4.02; p<0.001).

Socioeconomic factors were as follows: education (high school dropout: OR, 1.38, 95 percent CI, 1.22‒1.55; p<0.001), unhoused (OR, 4.23, 95 percent CI, 3.31‒5.36; p<0.001), and poverty (<$10,000 annually: OR, 3.02, 95 percent CI, 2.68‒3.41; p<0.001).

Associated overall health factors included Medicaid (OR, 2.41, 95 percent CI, 1.85‒3.16; p<0.001), poor mental health (OR, 1.82, 95 percent CI, 1.47‒2.25; p<0.001), poor quality of life (OR, 2.31, 95 percent CI, 1.83‒2.93; p<0.001), and poor health literacy (OR, 2.72, 95 percent CI, 2.16‒3.47; p<0.001).

Geographic areas with the highest maxillofacial trauma per capita were Vermont and New Hampshire.

“These findings underscore the need for further efforts to reduce health inequities and may help guide resource allocation toward groups at highest risk for maxillofacial trauma,” the researchers said.

“Database limitations precluded stratification by mechanism of injury, which may further inform public health strategies in future studies,” they added.