South Australian facial trauma: a population analysis of social economic deprivation and facial fractures

Background: Trauma remains a leading cause of morbidity and mortality in Australia. The objective of this South Australian study was to analyse epidemiological trends in facial fractures and assess the relationship between socioeconomic disadvantage and clinical outcomes. Part one of this paper includes methods and results; part two includes discussion and conclusion. The two papers should be read together. Method: A retrospective analysis of the relationship was conducted between socioeconomic disadvantage and facial fractures. All paediatric and adult patients with facial fractures who attended the Royal Adelaide Hospital and the Women’s and Children’s Hospital Adelaide between January 2012 and January 2017 either as in- or outpatients. The medical records, progress notes, imaging and operative notes from plastics, craniofacial and oral maxillofacial surgery teams were retrospectively collated into a registry and reviewed. Ethics approval was granted from the RAH Human Research and Ethics Committee [HREC/17/RAH/402]. Results: A total of 2559 patients, 1976 males (77.2%) and 583 females (22.8%), sustained a facial fracture. The most disadvantaged group had the highest proportion of facial fractures (36.9%), with the highest incidence in the 25–34 age group (22.4%). Assaults were the most common injury with decreasing odds as socioeconomic advantage increased (p<0.05). Orbitozygomatic fractures were the most common type of facial fracture (27.7%). Indigenous patients were more likely (OR=2.8) to have surgery compared to non–indigenous patients (p<0.05). There were no significant differences in length of stay between socioeconomic groups (F(4,964.387)=2.091, p = 0.080). Conclusion: Socioeconomic status strongly influences the mechanisms on injury, types of fracture and likelihood of surgery with the most disadvantaged having higher rates compared to the least disadvantaged.