Racial and Ethnic Disparities in Facial Paralysis: Diagnosis, Comorbidities, and Chemodenervation

Facial paralysis (FP) is associated with significant functional and psychosocial morbidity, yet potential racial and ethnic disparities in its diagnosis, associated comorbidities, and treatment patterns remain poorly characterized.

Patients with FP diagnoses were identified using International Classification of Diseases codes within the TriNetX Database. Cohorts of Caucasian and non-Caucasian (Black, Hispanic, and Asian) patients were matched for age and sex. Data on demographics, comorbidities, and chemodenervation rates were compared.

A total of 370,574 patients with a diagnosis related to FP were identified, of which 25.1% were non-Caucasian. Caucasian patients were less likely to be diagnosed with FP (OR 0.828, p < 0.0001) at rates of 7.1 versus 8.5 cases per 1000 individuals. Non-Caucasian FP patients were younger at time of diagnosis (mean 54.6 vs. 61.8 years), had a higher burden of Type 2 diabetes and hypertension, but lower rates of thyroid disease (p < 0.0001). Non-Caucasian FP patients were more likely than Caucasian counterparts to experience health hazards related to socioeconomic/psychosocial circumstances at rates of 10.2% vs. 7.1% (p < 0.0001). Notably, Caucasian FP patients received significantly more treatments with chemodenervation compared to non-Caucasian FP patients (OR 1.648, 95% CI, p < 0.0001).

Non-Caucasian patients may be more likely to be diagnosed with FP and experience more medical comorbidities compared to Caucasian patients; however, they may receive fewer chemodenervation treatments. Future studies should seek to investigate underlying differences in FP diagnosis as well as the true incidence of facial synkinesis among different racial and ethnic groups.