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Original Investigation
Nov/Dec 2016

Race and Sex Differences in Adult Facial Fracture Risk

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 3Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
  • 4Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 5Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
  • 6Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark
  • 7Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
JAMA Facial Plast Surg. 2016;18(6):441-448. doi:10.1001/jamafacial.2016.0714
Key Points

Question  Are there racial and sex difference in adult facial fracture risks?

Findings  In this analysis of National Electronic Injury Surveillance System data and adults with facial injury and fracture, there was an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, particularly among whites and Asians. Black women did not have this increased fracture risk with advancing age.

Meaning  Mechanisms of injury and facial fracture risk vary by age, race, and sex.

Abstract

Importance  There are well-described racial, sex, and age differences related to osteoporosis and hip and/or extremity fractures. Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture.

Objective  To characterize the incidence of facial fractures by patient demographics and injury mechanism, focusing on whether differences are noted with race, sex, and advancing age.

Main Outcomes and Measures  Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) was performed in October and November 2015, specifically evaluating adult emergency department (ED) visits from 2012 to 2014 related to facial trauma. Entries were organized by age groups (both individual decades as well as younger adults [18-59 years] vs older adults [60-89 years]), sex, and race (white, black, Asian, other/unspecified). Incidence of facial fractures and mechanism of injury were also evaluated.

Results  There were 33 825 NEISS entries correlating to 1 401 196 ED (range, 1 136 048-1 666 344) visits for adult facial injury, with 14.4% involving fracture. A greater proportion of facial injuries among younger men (<60 years) were fractures relative to younger women (15.5% vs 12.5%; difference of the mean [DOM], 3.0%; 95% CI, 2.8%-3.1%; P < .001); however, on comparison by sex in elderly populations (≥ 60 years), women had an increased fracture predilection (15.0% vs 14.0%; DOM, 1.0%; 95% CI, 0.8%-1.2%; P < .001). Also, older women had a significantly greater risk of fracture relative to those younger than 60 years (15.0% vs 12.5%; DOM, 2.5%; 95% CI, 2.4%-2.7%; P < .001), a comparison that was significant among whites and Asians. Black women had a significantly decreased risk of fracture in the older aged population. (8.4% vs 9.1%; DOM, 0.7%; 95% CI, 0.2%- 1.3%; P = .001). Both on individual comparisons of younger and older cohorts, white and Asian individuals of either sex had significantly greater rates of facial fracture injury than blacks. Among younger cohorts in either sex, injuries sustained during participation in recreational activities were a significant factor, replaced largely by injuries due to housing structural elements and falls among older cohorts.

Conclusions and Relevance  There is an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, with these results significant among whites and Asians. In contrast, a decreased risk was noted on comparison of younger and older black women. Mechanism of injuries also varied significantly by age, race, and sex.

Level of Evidence  4.

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