Area Deprivation Index and Social Determinants of Health: Association With Loss to Follow-Up After Facial Trauma
Matthew Ryan1, Syed Abdul-Wasay1, Nicholas Wilken2
1Resident, Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD.
Background:
Postoperative loss to follow-up in facial trauma patients is a persistent challenge potentially linked to adverse outcomes. However, factors associated with loss to follow-up remain poorly characterized.
Purpose:
The purpose of this study was to measure the association between socioeconomic deprivation, as defined by the Area Deprivation Index (ADI), and postoperative loss to follow-up within 90 days of discharge after operative management of facial trauma.
Study Design, Setting Sample:
This was a retrospective cohort study of all adults undergoing operative treatment for facial injuries at the University of Maryland Shock Trauma Center from 2021 to 2024. Patients who died within 90 days of discharge were excluded.
Predictor Variable:
The predictor was neighborhood socioeconomic deprivation measured using ADI national percentile rankings, categorized into quartiles.
Main Outcome Variable:
The primary outcome was loss to follow-up, defined as failure to attend any postoperative clinic visit within 90 days of discharge.
Covariates:
Covariates included demographic (race, distance to hospital), social (marital status, employment), and clinical characteristics (etiology, concomitant injuries).
Analyses:
Descriptive and bivariate analyses evaluated associations between ADI and loss to follow-up. Multivariable logistic regression assessed factors independently associated with loss to follow-up.
Results:
A total of 881 subjects were included, of which 663 (75.3%) attended follow-up and 218 (24.7%) did not. The cohort had a mean age of 40.8 ± 17.1 years, was 80% male (n = 704), and 47% White (n = 410). In bivariate analysis, higher ADI was associated with loss to follow-up, with subjects in the third (relative risk: 2.14; 95% CI: 1.31 to 3.50) and fourth quartiles (relative risk: 2.21; 95% CI: 1.31 to 3.73) having greater likelihood of missed follow-up compared to those in the first quartile. In adjusted analysis, ADI in the third (OR: 2.13; 95% CI: 1.13 to 4.03) or fourth quartile (odds ratio: 2.21; 95% CI: 1.09 to 4.45) remained independently associated with loss to follow-up. Emergency department utilization occurred in 59 subjects (6.70%); one-quarter received all postoperative care in the emergency department.
Conclusions And Relevance:
Neighborhood socioeconomic deprivation is independently associated with loss to follow-up after facial trauma surgery. Targeted interventions addressing structural barriers may improve continuity of care and reduce avoidable health care utilization in this demographic.
