(94) Do Sociodemographic Factors Influence Treatment Rendered for Mandible Fracture Patients?

Abstract: Past epidemiological studies have shown that facial fractures are seen more frequently with certain demographic groups. Specifically, mandibular fractures are more likely to occur in males, drug and alcohol users, and low socioeconomic status patients. However, there has been no investigation to this point regarding whether these demographic factors influence the care that these patients receive. In particular, the decision to treat a fracture in an open versus closed manner may be influenced by social health determinants or unconscious bias on the part of the treating provider. We sought to investigate the relationship between patient demographics and the chosen treatment modality for mandible fracture patients. We hypothesized that patients of underserved groups would be more likely to undergo open treatment. A retrospective analysis was performed of mandibular fractures received by the John H. Stroger, Jr. Hospital of Cook County trauma unit between 2016 and 2024. Patient chart reviews were completed, and data were collected regarding patient demographics, treatment modality and complication rates. A chi-squared analysis was performed and there were several notable findings. Younger patients underwent closed reduction internal fixation (CRMMF) at a significantly higher rate than older patients (P = .0029). English-speaking patients were more likely to undergo CRMMF than non-English-speaking patients to a degree approaching statistical significance (P = .0592). There was also a difference in treatment modality noted among patients with different insurance status, with incarcerated patients undergoing CRMMF at a higher rate to a degree approaching statistical significance (P = .0682). There was no significant difference in treatment modality noted based on median household income (P = .3855), race (P = .3965), ethnicity (P = .8202), or sex (P = .4715). There was no significant difference noted in complication rates on the basis or either demographics or treatment modality. Surgeons may believe that younger patients are more likely to tolerate the CRMMF postoperative course and restricted diet, contributing to the age-related disparity. It is also possible that surgeons are less likely offer CRMMF to non-English speaking patients given the language barrier and that the use of an interpreter can significantly lengthen the already extended conversations that often accompany the discussion around treatment options and the care involved in CRMMF. Incarcerated patients may be more likely to be treated with CRMMF given that it is easier to control their diet and postoperative follow-up. Further investigation is warranted to examine these discrepancies in patient management to determine the best ways to ensure equitable high-quality care for our patients.



Citations:


Relation between facial fractures and socioeconomic deprivation in the north east of England
Goodfellow, M. et al.
British Journal of Oral and Maxillofacial Surgery, Volume 57, Issue 3, 255 - 259

Baseline Characteristics and Treatment Preferences of Oral Surgery Patients
Atchison, Kathryn A. et al.
Journal of Oral and Maxillofacial Surgery, Volume 65, Issue 12, 2430 – 2437

Hernandez, J., Demiranda, L., Perisetla, P. et al. A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health 24, 1713 (2024). https://doi.org/10.1186/s12889-024-19166-6