Socioeconomic Factors Affect The Treatment Of Mandibular Fractures
Thomas Q. Xu, MD, Taylor J. Jarazcewski, MS, Aaron L. Wiegmann, MD, Ethan M. Ritz, MS, Todd Beck, MS, Carlos A. Q. Santos, MD, MPHS, Christina Tragos, MD, Amir H. Dorafshar, MBChB.
Rush University Medical Center, Chicago, IL, USA.
PURPOSE: Health care disparities have been reported throughout medicine for decades. While blatant explicit bias is not prevalent, a substantial body of research has been published suggesting that systemic biases related to sex, race, income, and insurance status likely exist. To our knowledge, no study has assessed the effect of patient socioeconomic status on clinical decision-making in facial fracture repair. Thus, the objective of this project was to assess if socioeconomic factors impact whether patients obtain open versus closed treatment of mandibular fractures.
METHODS: Data were extracted from the 2012 and 2013 National Inpatient Sample (NIS). Patients that had either open or closed treatment were included for analysis. Patients who had a length of stay longer than three days or died during their inpatient stay were excluded. These criteria were used to exclude patients with polytrauma as well as complicated fractures. Chi-squared tests were performed to test for univariate associations between race, sex, insurance payer and procedure done. A logistic model was then used to test for these factors simultaneously.
RESULTS: Initial data provided a total of 2481 patients who underwent open and 933 patients who underwent closed treatment. Statistically significant differences were present within the race, sex and insurance payer status groups (p < 0.05). Patients of black and Hispanic race had decreased odds of undergoing closed treatment (OR = 0.775, 0.725 respectively) compared to patients of white race. Further, self-paying patients had decreased odds of undergoing closed treatment (OR = 0.818) compared to privately insured patients. Finally, we found that female patients had increased odds of undergoing closed treatment (OR = 1.511).
CONCLUSION: Our results reveal that certain socioeconomic factors do affect the management of mandibular fractures. Specifically, patients who are female, white or have private insurance have a higher likelihood of being treated with closed treatment. Further analysis will be needed to determine the underlying etiology of these socioeconomic and sex disparities.
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