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Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution
Andrew J Deek1, Devin J Clegg2, Rebecca A Deek3
1Pediatric Craniofacial Surgery Fellow, Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA.
Insights
Pediatric craniomaxillofacial (CMF) trauma rates were not linked to urban or rural county designation alone. However, lower income and population density were associated with higher CMF injury risks in children.
Area of Science:
- Public Health
- Pediatric Surgery
- Trauma Surgery
Background:
- Pediatric populations in rural and low-income areas face elevated trauma risks.
- Craniomaxillofacial (CMF) trauma in these vulnerable pediatric groups remains understudied.
- Understanding geographic and socioeconomic disparities in pediatric CMF trauma is crucial for targeted interventions.
Purpose of the Study:
- To investigate whether rural or low-income populations experience higher rates of pediatric CMF trauma compared to urban or high-income populations.
- To identify differences in the mechanisms of injury (MOI) for pediatric CMF trauma across these demographic groups.
- To analyze the interplay between geographic residence, socioeconomic status, and pediatric CMF trauma incidence.
Main Methods:
- A retrospective cohort study analyzed pediatric CMF trauma patients (<17 years) treated between 2011 and 2022.
- Geographic residence (rural/urban) and postal code (PC) socioeconomic data (median household income [MHI], population density) were key predictor variables.
- Pediatric CMF injury rates per 100,000 were the primary outcome, with MOI as a secondary outcome.
Main Results:
- No significant difference in CMF trauma rates was found between rural and urban county designations (IRR=0.91, P=0.18).
- Increased MHI was associated with decreased CMF trauma rates, particularly in rural counties (24% reduction).
- Lower PC income (IRR=0.91, P=0.004) and lower population density (IRR=0.87, P<0.001) correlated with higher CMF trauma rates.
Conclusions:
- Children residing in postal codes with lower population density or income face the highest risk of CMF injuries.
- Mechanisms of injury varied by age, with dog bites and falls common in younger children and interpersonal violence in older children.
- Tennessee's urban/rural designation interacts complexly with MHI and pediatric CMF trauma rates, necessitating nuanced public health strategies.
Background:
Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied.
Purpose:
This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI).
Study Design, Setting, Sample:
A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records.
Predictor Variable:
The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density.
Main Outcome Variable(S):
The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable.
Covariate(S):
Covariates included sex, age, and race.
Analyses:
Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05.
Results:
Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR) = 0.91; 95% confidence interval (CI) 0.78 to 1.05; P = .18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR = 0.91; 95% (CI) 0.86 to 0.97; P = .004), and higher population density (IRR = 0.87; 95% CI 0.79 to 0.94; P < .001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients.
Conclusions And Relevance:
Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.
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