Does Socioeconomic Deprivation Correlate With Follow-Up Adherence and Clinical Outcomes in Patients With Mandible Fractures?

BACKGROUND

Socioeconomic deprivation influences mandibular fracture prevalence, but its effect on surgical outcomes is understudied.

PURPOSE: To evaluate the association between area deprivation index (ADI), a neighborhood-level measure of socioeconomic disadvantage, and follow-up appointment adherence and clinical outcomes after mandible fracture surgery.

STUDY

DESIGN

Retrospective cohort study of patients aged 18 to 89 years treated for mandible fractures at Boston Medical Center from January 1, 2018, to December 31, 2022.

EXCLUSIONS: isolated alveolus fractures, pathologic fractures, incomplete chart data, or revision procedures.

PREDICTOR VARIABLE: Neighborhood-level socioeconomic deprivation, measured using ADI scores and categorized into low deprivation (score 1 to 5) or high deprivation (score 6 to 10).

MAIN OUTCOME VARIABLES: Primary - postoperative follow-up adherence (appointment attendance frequency). Secondary - postoperative complications and 30-day hospital readmission.

COVARIATES: Demographics, socioeconomic risk factors, physiologic factors, and surgical treatment details.

ANALYSES: Statistical analyses included Mann-Whitney U test, χ2 test, and Fisher's exact test. Multiple Poisson regression with log link assessed the relationship between independent variables and patient outcomes. Statistical significance set at P value < .05.

RESULTS

Of 1201 patients screened, 368 (33.4%) met inclusion criteria (mean age 40.9 years ± 17.1, 277 (75.3%) male). There were 197 (53.5%) and 171 (46.5%) subjects in the high- and low-ADI groups, respectively. In the high- and low-ADI groups, 84 (45.4%) and 97 (60.6%) subjects achieved a follow-up frequency of ≥70%, respectively (P = .005). Postoperative complications occurred in 30 (16.2%) and 30 (18.8%) subjects in the high- and low-ADI groups, respectively (P = .5), and 30-day readmission occurred in 12 (6.5%) and 13 (8.1%) of subjects, respectively (P = .6). In multiple Poisson regression, high ADI remained a statistically significant predictor of lower follow-up adherence (relative risk 0.81; 95% CI 0.67 to 0.99; P = .04), as did public insurance and current smoking status (relative risks 0.69 and 0.65, respectively; both P < .001).

CONCLUSION AND RELEVANCE: Greater socioeconomic deprivation is associated with reduced follow-up adherence after mandible fracture repair (correlating with insurance status and cigarette use) but not with increased postoperative complications or 30-day readmissions. While ADI alone may have limited predictive value, it may contribute to broader risk models for identifying patients at risk for disengagement.