Assessing the Area Deprivation Index in Relation to Orbital Floor Fractures.

Abstract

Social determinants of health are acknowledged as significant factors affecting trauma occurrence, severity, and outcomes. The area deprivation index (ADI) is a validated tool that combines social determinants into a single measure of "neighborhood disadvantage." We aimed to investigate whether ADI was linked to injury severity and other clinical benchmarks in orbital floor fracture patients. Patients presenting to a single Level 1 Emergency Department with acute orbital floor fracture were reviewed. Data on additional trauma, length of stay (LOS), and follow-up attendance were collected. Patients were classified into a stable, urgent, or critical condition based on initial clinical presentation. Neighborhood socioeconomic disadvantage was evaluated using national percentile and state decile ADI. Analyses were conducted using chi-squared tests, Mann-Whitney U, Spearman rank correlations, and Kruskal-Wallis tests. A total of 1255 patients with acute orbital floor fractures were analyzed. ADI was significantly higher in patients with additional facial trauma (national ADI: 55 vs. 51, p = 0.0240; state ADI: 7 vs. 6, p = 0.0119). However, ADI was not significantly associated with the incidence of bodily polytrauma, initial clinical acuity, or LOS. Follow-up attendance rates did not differ by ADI. Social disadvantage was significantly associated with differences in injury characteristics and indirectly with care utilization among orbital floor fracture patients. This may reflect different mechanisms of injury in high ADI areas and indicate that ADI may be useful as a contextual marker of injury severity. Future studies should investigate these mechanisms and other risk factors unique to high ADI areas.