South Australian facial trauma: a population analysis of social economic deprivation and facial fractures part two

Main Article Content

Jason Diab
Benjamin Grave
Walter Flapper
Peter Anderson
David J David
Mark Moore


South Australia, facial injuries, social class, socioeconomic factors, registries


Background: Trauma remains a leading cause of morbidity and mortality in Australia. The objective of this South Australian study was to analyse epidemiological trends in facial fractures and assess the relationship between socioeconomic disadvantage and clinical outcomes. Part one of this paper includes methods and results; part two includes discussion and conclusion. The two papers should be read together.

Method: A retrospective analysis of the relationship was conducted between socioeconomic disadvantage and facial fractures. All paediatric and adult patients with facial fractures who attended the Royal Adelaide Hospital and the Women’s and Children’s Hospital Adelaide between January

2012 and January 2017 either as in- or outpatients. The medical records, progress notes, imaging and operative notes from plastics, craniofacial and oral maxillofacial surgery teams were retrospectively collated into a registry and reviewed. Ethics approval was granted from the RAH Human Research and Ethics Committee [HREC/17/RAH/402].

Results: A total of 2559 patients, 1976 males (77.2%) and 583 females (22.8%), sustained a facial fracture. The most disadvantaged group had the highest proportion of facial fractures (36.9%), with the highest incidence in the 25–34 age group (22.4%). Assaults were the most common injury with decreasing odds as socioeconomic advantage increased (p<0.05). Orbitozygomatic fractures were the most common type of facial fracture (27.7%). Indigenous patients were more likely (OR=2.8) to have surgery compared to non–indigenous patients (p<0.05). There were no significant differences in length of stay between socioeconomic groups (F(4,964.387)=2.091, p = 0.080).

Conclusion: Socioeconomic status strongly influences the mechanisms on injury, types of fracture and likelihood of surgery with the most disadvantaged having higher rates compared to the least disadvantaged.


Metrics Loading ...
Abstract 82 | HTML Downloads 33 PDF Downloads 40


14. Wise P, Matthews R. Research paper: Socio-economic indexes for areas: getting a handle on individual diversity within areas [PDF on Internet]. Canberra: Australian Bureau of Statistics. [Released 12 September 2011; cited September 2020]. Available from:[email protected]/mf/1351.0.55.036
15. Moncrieff NJ, Qureshi C, Deva AK. A comparative cost analysis of maxillofacial trauma in Australia. J Craniofac Surg. 2004;15(4):686–91. PMid:15213554
16. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Cranio-maxillo-facial Surg. 2003;31(1):51–61.
17. Telfer MR, Jones GM, Shepherd JP. Trends in the aetiology of maxillofacial fractures in the United Kingdom (1977–87). Br J Oral Maxillofac Surg. 1991;29(4):250–55.
18. Hutchison IL, Magennis P, Shepherd JP, Brown AE. The BAOMS United Kingdom survey of facial injuries part 1: aetiology and the association with alcohol consumption. Br J Oral Maxill Surg. 1998;36(1):3–13.
19. Chen HY, Ivers RQ, Martiniuk ALC, Boufous S, Senserrick T, Woodward M, Stevenson M, Norton R. Socioeconomic status and risk of car crash injury, independent of place of residence and driving exposure: results from the DRIVE Study. J Epidemiol Community Health. 2010;64(11):998–1003. PMid:19822556
20. van den Bergh B, Karagozoglu KH, Heymans MW, Forouzanfar T. Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients. J Craniomaxillofac Surg. 2012;40(6):165–69. PMid:21917471
21. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associated injuries in facial fractures: review of 839 patients. Br J Plast Surg. 1993;46(8):635–38.
22. Adi M, Ogden GR, Chisholm DM. An analysis of mandibular fractures in Dundee, Scotland (1977–85). Br J Oral Maxillofac Surg. 1990;28(3):194–99.
23. Baumann M, Spitz E, Guillemin F, Ravaud JF, Choquet M, Falissard B, Chau N, Lorhandicap group. Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study. Int J Health Geogr. 2007;6:50. PMid:17996098 PMCid:PMC2211297
24. Wilson MH, Robinson JP, Sisson RT, Revington PJ, Thomas SJ. The effect of deprivation on the incidence of mandibular fractures in a British city. Surgeon. 2017;15(2):65–68. PMid:27167904
25. Kruger E, Smith K, Tennant M. Jaw fractures in the indigenous and non-indigenous populations of Western Australia: 1999–2003. Int J Oral Maxillofac Surg. 2006;35(7):658–62. PMid:16513326
26. Australian Institute of Health and Welfare. Family violence among Aboriginal and Torres Strait Islander peoples, cat. no. IHW 17 [web report]. Canberra: Commonwealth of Australia. [Released 1 November 2006; cited 3 May 2020]. Available from:
27. Khalifeh H, Hargreaves J, Howard LM, Birdthistle I. Intimate partner violence and socioeconomic deprivation in England: findings from a national cross-sectional survey. Am J Pub Health. 2013;103:462–72. PMid:22897532 PMCid:PMC3673488
28. Loxton D, Townsend N, Forder P, Coombe J. Domestic violence, risk factors and health: Australian longitudinal study on women’s health, research centre for generational health and ageing [PDF on Internet]. Newcastle: University of Newcastle. [Published August 2018; cited 2 April 2020]. Available from:
29. Velayutham L, Sivanandarajasingam A, O’Meara C, Hyam D. Elderly patients with maxillofacial trauma: the effect of an ageing population on a maxillofacial unit’s workload. Br J Oral Maxillofac Surg. 2013;51(2):128–32. PMid:22677216.
30. Cripps R, Carman J. Falls by the elderly in Australia: trends and data for 1998, injury research and statistics series, cat. no. INJCAT 35 [PDF on Internet]. Adelaide: Australian Institute of Health and Welfare. [February 2001; cited September 2020].
31. Jeschke MG, Patsouris D, Stanojcic M, Abdullahi A, Rehou S, Pinot R, et al. Pathophysiologic response to burns in the elderly. E Biomedicine. 2015;2(10):1536–548. PMid:26629550 PMCid:PMC4634201
32. Atisha DM, Burr Tv, Allori AC, Puscas L, Erdmann D, Marcus JR. Facial fractures in the aging population. Plast Reconstr Surg. 2016;137(2):587–93, PMid:26818295
33. Salmon J, Timperio A, Cleland V, Venn A. Trends in children’s physical activity and weight status in high and low socioeconomic status areas of Melbourne, Victoria, 1985–2001. Aust N Z J Public Health. 2005;29(4):337–42. PMid:16222931
34. Dollman J, Lewis NR. The impact of socioeconomic position on sport participation among South Australian youth.
J Sci Med Sport. 2010;13(3):318–22. PMid:19560973
35. Eurostat, European Commission of Employment, Social Affairs and Equal Opportunities. Health and safety at work in Europe (1999–2007): a statistical portrait [PDF on Internet]. Luxembourg: Publications Office of the European Union. [Released 20 July 2010; cited September 2020]. Available from:
36. Schröter C, Schulte-Sutum A, Zeckey C, Winkelmann M, Krettek C, Mommsen P. Unfälle im Reitsport: Analyse von Verletzungsmechanismen und -mustern (Accidents in equestrian sports: analysis of injury mechanisms and patterns). Unfallchirurg. 2017;120(2):129–38. PMid:26449915
37. Shahim FN, Cameron P, McNeil JJ. Maxillofacial trauma in major trauma patients. Aust Dental J. 2006;51(3):225–30. PMid:17037888
38. Hogg NJ, Stewart TC, Armstrong JE, Girotti MJ. Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma. 2000;49(3):425e32. PMid:11003318
39. Alvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope. 2003;113(1):102–06. PMid:12514391
40. Edwards TJ, David DJ, Simpson DA, Abbott AA. Patterns of mandibular fractures in Adelaide, South Australia. ANZ J Surg. 1994;64:307–11. PMid:8179524
41. Olson RA, Fonseca RJ, Zeitler DL, Osbon DB. Fractures of the mandible: a review of 580 cases. J Oral Maxillofac. Surg. 1982;40(1):23–28.
42. Ellis E, Moos KF, El-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985;5:120–29.
43. Hackl W, Hausberger K, Sailer R, Ulmer H, Gassner R. Prevalence of cervical spine injuries in patients with facial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(4):370–76. PMid:11598569
44. Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg. 1995;24(1):26–29.
45. Hohlrieder M, Hinterhoelzl J, Ulmer H, Hackl W, Schmutzhard E, Gassner R. Maxillofacial fractures masking traumatic intracranial hemorrhages. Int J Oral Maxillofac Surg. 2004;33(4):389–95. PMid:15145043
46. Kruger E, Tennant M. Socioeconomic disadvantage and oral-health-related hospital admissions: a 10-year analysis. BDJ Open. 2016;2:16004. PMid:29607065 PMCid:PMC5842864
47. Slade GD, Spencer AJ, Roberts-Thomson KF, eds. Australia’s dental generations: the national survey of adult oral health 2004–06, dental statistics and research series no. 34, cat. no. DEN 165 [PDF on Internet]. Canberra: Australian Institute of Health and Welfare. ). [Published 2007; cited September 2020]. Available from:
48. Zarzaur BL, Croce MA, Fabian TC, Fischer P, Magnotti LJ. A population-based analysis of neighborhood socioeconomic status and injury admission rates and in-hospital mortality. J Am Coll Surg. 2010;211(2):216–23. PMid:20670859 PMCid:PMC3042251
49. Erikson R, Torssander J. Social class and cause of death. Eur J Public Health. 2008;18(5):473–78. PMid:18562463
50. Kristensen P, Kristiansen T, Rehn M, Gravseth HM, Bjerkedal T. Social inequalities in road traffic deaths at age 16–20 years among all Norwegians born between 1967 and 1976: a multilevel analysis. Inj Prev. 2012;18(1):3–9. PMid:21606470 PMCid:PMC3262988
51. Erdogan M, Kureshi N, Karim SA, Tallon JM, Asbridge M, Green RS. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. BMJ Open. 2018;8(11):e024190. PMid:30429147 PMCid:PMC6252682
52. Shepherd CC, Li J, Zubrick SR. Social gradients in the health of Indigenous Australians. Am J Public Health. 2012;102(1):107–17. PMid:22095336 PMCid:PMC3490556

Most read articles by the same author(s)