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Original Investigation |

Race and Sex Differences in Adult Facial Fracture Risk ONLINE FIRST

Curtis Hanba, BS1; Peter F. Svider, MD1; Frank S. Chen, MD, PhD1; Michael A. Carron, MD1,2; Adam J. Folbe, MD1,3; Jean Anderson Eloy, MD4,5,6,7; Giancarlo F. Zuliani, MD1,2
[+] 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. Published online July 14, 2016. doi:10.1001/jamafacial.2016.0714
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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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Figure 1.
Sex and Race Differences in Fracture Risk by Decade

A, Sex comparison of fracture by decade. B, Overall racial comparison of fracture. Legend details which lines correspond to which racial cohort. C, Fracture risk among men organized by age and race. D, Fracture risk among women organized by age and race. % Fracture indicates the proportion of facial injuries diagnosed as a fracture. Each data point included is an average by decade.

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Figure 2.
Comparisons of Facial Fracture Risk

A, Comparison between younger (<60 years) and older (≥60 years) adults. B, Further breakdown by race.

aStatistically significant comparison between the younger and older cohorts for a particular comparison (P < .05).

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Figure 3.
Comparison of Fracture Risk Between Younger and Older Adults Organized by Race

A, Men. B, Women.

aStatistically significant comparison between the younger and older cohorts for a particular comparison (P < .05).

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Figure 4.
Mechanism of Injury Among Younger vs Older Men and Women

A, Younger men. B, Older men. C, Younger women. D, Older women.

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