Substance Use, Homelessness Poverty, Minority Race Highest Risk Factors for Maxillofacial Trauma

Study shows that maxillofacial trauma remains a substantial nationwide health challenge, with far-reaching physical, socioeconomic and psychological consequences. Further efforts to reduce health inequities and help guide resource allocation toward groups at highest risk for maxillofacial trauma are needed. Photo: James Milite, MD.  Click image to enlarge. Orbital fractures are among the most common injuries seen following maxillofacial trauma. Given the vision-threatening nature of these injuries and the associated public impact, maxillofacial trauma may pose detrimental biopsychosocial effects at the individual, community and societal levels. In a recent study, researchers investigated associations between social determinants of health (SDOH) and maxillofacial trauma in the All of Us (AoU) Research Program. They found substance use, homelessness, poverty and American Indian and Black races to be the highest SDOH risk factors of maxillofacial trauma. The findings were reported in Ophthalmology.Included were 23,184 controls and 5,796 patients with orbital fractures, facial fractures or combination thereof in AoU. Retrospective analysis was performed using electronic health records and survey data from AoU. Cases of orbital and facial fractures were identified and a randomized 1:4 ratio was used to generate a control sample.The authors observed a 1.5-fold increased risk of maxillofacial trauma among Black individuals and a threefold increased risk among American Indian/Alaska Native individuals, whereas the Asian race was found to be protective. “Overall, these racial disparities may be influenced by a multitude of inciting factors including economic determinants (e.g., income inequality, food insecurity), social factors (e.g., discrimination, lack of social support), environmental variations (e.g., segregated or under-resourced neighborhoods) and structural barriers (e.g., policies, intergenerational cycles, justice system),” the authors explained in their paper.Individuals consuming 10 or more drinks daily were associated with a more than fourfold increased risk. Similarly, the twofold increased risk among cigarette smokers and the nearly fourfold increased risk among users of street opioids highlight the association of high-risk behaviors in individuals experiencing maxillofacial trauma.Another key finding is the high risk among individuals who are homeless, where a greater than fourfold increased danger of injury was observed. This population is exposed to a higher risk of interpersonal violence, accidental falls and other forms of trauma with limited access to protective resources and healthcare, underscoring “the critical role of stable housing as a fundamental determinant of health and safety,” the authors wrote in their paper. “The decreased risk observed in those living on a college campus further supports the notion that a stable and structured living environment can be protective against such injuries.”Socioeconomic status and education level were also found to be associated with maxillofacial trauma, with high school dropouts and those in poverty having an increased risk compared to college-educated and higher-income individuals.What the authors found interesting is that public insurance beneficiaries, such as those on Medicaid and Medicare, experience a disproportionately higher burden of maxillofacial trauma compared to uninsured patients. Possible underreporting in this population due to less likelihood of seeking timely trauma care may play a part. These findings are consistent with previous data which established insurance status as a key SDOH that influences injury risk overall.Psychological state was found to be a significant, yet previously under-recognized, risk factor, with self-reported poor mental health and lower quality of life significantly associated with an increased risk of injury. The authors noted that is consistent with the overarching pattern in trauma literature, which has demonstrated a link between psychological distress and an elevated risk for physical injuries, such as falls and fractures—suggesting that psychological distress may impair cognitive functions like judgment and situational awareness. “Alternatively, it may precipitate unsafe behaviors that increase an individual's exposure to hazardous environments, thereby increasing one’s susceptibility to traumatic events,” the authors added in their paper.Geographically speaking, Vermont, New Hampshire, Mississippi, Massachusetts and Iowa were the highest in relative maxillofacial trauma volume per capita nationwide when normalized to AoU enrollment. Vermont, New Hampshire and Massachusetts may stand out due to having the highest rate of motor vehicle accidents nationwide based on insurance data in 2024, a previous study shows. Furthermore, residents may have easier access to trauma care as this region holds several large and busy major Level 1 trauma centers all in close proximity. Mississippi has historically been among the nation’s poorest states and has lower educational attainment relative to much of the country.Early recognition through screening protocols and timely radiographic imaging when there is maxillofacial trauma is an informed care approach providers can take. “In addition, efforts to close post-injury care gaps via health hazard evaluations with referral of those at highest risk to social services, including addiction counselors and housing support to mitigate environments prone to maxillofacial trauma, are necessary,” the authors concluded in their paper. “Secondary prevention through patient education (e.g., eye protection, fall prevention and safety measures) tailored to high-risk groups, as well as enhanced efforts towards data tracking and acquisition to allow expansion of existing knowledge are needed.” Click here for the journal source. Azzam DB, Meller L, Aucoin A, et al. Social determinants of health associated with orbital and facial fractures in the United States using NIH All of Us Research Program. Ophthalmology. February 10, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.