Faces of inequality: social determinants of health in interpersonal violence–related facial fractures – a case-control study

Abstract

Background: Physical violence often leads to significant long-term consequences and is recognized as the leading cause of death among adolescents and young adults in many parts of the world. Interpersonal violence (IPV) is also the most common cause of facial fractures. Associated behaviors such as alcohol and drug use contribute to these IPV-related facial fractures. This present study was a part of the SOCE-trial (Sociodemographic Factors Behind Craniomaxillofacial Emergencies), which aims to clarify the factors associated with emergency treatment for craniomaxillofacial conditions. This study focused on facial fractures caused by IPV. Methods: This retrospective case-control study utilised data of patients with emergency visits at the oral and maxillofacial emergency unit of the Helsinki University Hospital for a facial fracture caused by IPV from 2013 to 2020. The data was combined with Statistics Finland and for each study subject, controls were randomly selected from the population of the same area as the cases. Results: Of the patients 88.1% were male, significantly more than in the control group (48.9%, p <.0001). Cases had also significantly lower education, socioeconomic status and income compared to the controls. Fracture patients were more often of the lowest level of education (OR 9.8, 95% CI 7.62-12.613.1, 95% CI 2.67–3.51), lowest income quartile (OR 7.1, 95% CI 5.56-9.02O R7 83.5, 95% CI 2.98-4.00) and unemployed (OR 14.5, 95% CI 10.39-20.25. Conclusions: Facial fractures caused by IPV were associated with lower income and education. These patients are in economically compromised situation, and this should be considered when treating this patient group.