Abstract
PURPOSE: To investigate associations between social determinants of health (SDOH) and maxillofacial trauma in the All of Us (AoU) Research Program. DESIGN: Cross-sectional, population-based. PARTICIPANTS: A total of 23 184 controls and 5796 patients with orbital fractures, facial fractures, or combination thereof in AoU. METHODS: Retrospective analysis was performed using electronic health records and survey data from AoU. Cases of orbital and facial fractures were identified, and a randomized 1:4 ratio was used to generate a control sample. Univariate t test and chi-square and multivariable logistic regression analyzed associations between SDOH factors and maxillofacial trauma within the AoU Researcher Workbench. Unmeasured confounding was also assessed. MAIN OUTCOME MEASURES: Statistical significance of SDOH risk factors for maxillofacial trauma thresholded at P < 0.0036 per Bonferroni correction. RESULTS: Demographic factors associated with maxillofacial trauma included male gender (odds ratio [OR], 2.09 [95% confidence interval, 1.99-2.21], P < 0.001), American Indian race (OR, 3.08 [2.68-3.53], P < 0.001), and Black race (OR, 1.53 [1.44-1.64], P < 0.001). Lifestyle factors involved alcohol use (≥10 drinks daily, OR, 4.59 [3.76-5.6], P < 0.001), cigarette smoking (OR, 2.18 [2.05-2.31], P < 0.001), and street opioids (OR, 3.53 [3.09-4.02], P < 0.001). Socioeconomic factors included education (high school dropout, OR, 1.38 [1.22-1.55], P < 0.001), unhoused (OR, 4.23 [3.31-5.36], P < 0.001), and poverty (<$10 000 annually, OR, 3.02 [2.68-3.41], P < 0.001). Overall health factors associated were Medicaid (OR, 2.41 [1.85-3.16], P < 0.001), poor mental health (OR, 1.82 [1.47-2.25], P < 0.001), poor quality of life (OR, 2.31 [1.83-2.93], P < 0.001), and poor health literacy (OR, 2.72 [2.16-3.47], P < 0.001). Geographic areas of highest maxillofacial trauma per capita were Vermont and New Hampshire. CONCLUSIONS: This nationwide cohort study provides evidence that significant SDOH are present in patients with maxillofacial trauma. The strongest identified factors were substance use, unhoused status, poverty, American Indian race, and Black race. 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. Database limitations precluded stratification by mechanism of injury, which may further inform public health strategies in future studies. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.