Trends in the incidence, prevalence and years lived with disability of facial fracture at global, regional and national levels from 1990 to 2017

Abstract

Background: Facial fracture is one of the most common injuries globally. Some types of facial fractures may cause irreversible damage and can be life-threatening. This study aimed to investigate the health burden of facial fractures at the global, regional, and national levels from 1990 to 2017.

Methods: Facial fracture data, including the incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2017, were obtained from the Global Burden of Disease study. We calculated the estimated annual percentage changes (EAPCs) to assess the changes of facial fractures in 195 countries or territories and 21 regions.

Results: From 1990 to 2017, the change in cases of facial fracture incidence was 39% globally, while the age-standardized incidence rate showed a downtrend with an EAPC of 0.00. Syria experienced a ten-fold increase in incidence cases with an EAPC of 9.2, and this condition is largely responsible for the global health burden of facial fractures. The prevalence and YLDs showed a similar trend worldwide as the incidence. Additionally, we found that the incidence, prevalence, and YLDs showed a discrepancy among various age groups with a gradual change of proportion over the past 28 years. The age-standardized rates (ASRs) of facial fractures were nearly twice for male than those for female from 1990 to 2017.

Conclusions: EAPC showed a correlation with the ASRs of facial fractures and had no relationship with socio-demographic index. The proportion of children and elderly suffering from facial fractures slightly changed with time. The ratio of facial fractures between males and females was 2:1. These findings suggest that more targeted and specific strategies based on age and gender should be established in various countries and regions.

Keywords: Facial fractures; Global burden of disease; Incidence; Prevalence; Years lived with disability.

Figure 1. The global incidence burden of facial fractures between 1990 and 2017 in 195 countries or territories.

(A) The ASIR of facial fractures in 2017. (B) The relative change in incident cases of facial fractures between 1990 and 2017. (C) The EAPC in ASIR of facial fractures from 1990 to 2017. The color shade presents the level of ASIR of facial fractures in 2017, percentage CIC of incident facial fractures, and EAPC in ASIR of facial fractures between 1990 and 2017 among 195 countries or territories. Warm color tone presents a high level while cold tone a lower level. The top three locations with the highest ASIR, CIC and EAPC in ASIR of facial fractures are marked in the maps respectively. ASIR, age-standardized incidence rate; CIC, change in cases; EAPC, estimated annual percentage change.

Figure 2. The association between age standardized rate of facial fractures and SDI among 21 regions between 1990 and 2017.

(A) ASIR and SDI. (B) ASPR and SDI. (C) Age-standardized YLDs rate and SDI. Each color represents a specific region. X-axis presents the SDI for each region and Y-axis presents corresponding ASIR (a), ASPR (b) and age-standardized YLDs rate (c) of facial fractures. Dots with the same color show the change trend of facial fractures in one region from 1990 to 2017.The fitted curve indicates that facial fractures varies widely with different SDI over 28 years. ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability; SDI, socio-demographic index.

Figure 3. The EAPC of facial fractures in 21 regions from 1990 to 2017.

(A) The EAPC of ASIR. (B) The EAPC of ASPR. (C) The EAPC of age-standardized YLDs rate. X-axis presents 21 different regions and Y-axis presents the EAPC of ASIR (A), ASPR (B) and age-standardized YLDs rate (C) of facial fractures respectively. The positive value of EAPC indicates an increasing trend in corresponding ASR of facial fractures whilst the negative value shows a downtrend. The EAPC across 21 regions are shown in 95% confidence interval (CI). EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability; ASR, age-standardized rate.

Figure 4. The change trends of age-standardized rate of facial fractures among distinct SDI quintiles and gender from 1990 to 2017.

(A) ASIR. (B) ASPR. (C) Age-standardized YLDs rate. The SDI of 21 regions are classified in quintiles. Each shape and color of dots present specific SDI quintile. The results are shown in both sexes, males and females. The curves show the different changing trend of facial fractures among distinct SDI quintiles in males, females and both sexes over last 28 years. ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability; SDI, socio-demographic index; ASR, age-standardized rate.

Figure 5. The correlation between EAPC and age standardized rate of facial fractures in 1990 as well as SDI in 2017 among 194 countries or territories.

(A) EAPC and ASIR. (B) EAPC and SDI in incidence. (C) EAPC and ASPR. (D) EAPC and SDI in prevalence. (E) EAPC and age-standardized YLDs rate. (F) EAPC and SDI in YLDs. The dots represent countries that were available on SDI data. The indices ρ and p values presented are obtained from Pearson correlation analysis. The EAPC shows a negative correlation with corresponding ASRs and not related with SDI among 194 countries or territories. EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability; ASR, age-standardized rate.

Figure 6. The global prevalence burden of facial fractures in 195 countries and territories.

(A) The ASPR of facial fractures in 2017. (B) The change in prevalent cases of facial fractures between 1990 and 2017. (C) The EAPC of facial fractures ASPR from 1990 to 2017. The color shade presents the level of ASPR of facial fractures in 2017, percentage CIC of prevalent facial fractures, and EAPC in ASPR of facial fractures between 1990 and 2017 among 195 countries or territories. Warm color tone presents a high level while cold tone presents a lower level. The top three locations with the highest ASPR, CIC of prevalent facial fractures and EAPC in ASPR are marked in the maps respectively. ASPR, age-standardized prevalence rate; CIC, change in cases; EAPC, estimated annual percentage change.

Figure 7. The global YLDs burden of facial fractures in 195 countries and territories.

(A) The age-standardized YLDs rate of facial fractures in 2017. (B) The change years lived with disability owning to facial fractures between 1990 and 2017. (C) The EAPC of facial fractures age-standardized YLDs rate from 1990 to 2017. The color shade represents the level of age-standardized YLDs rate of facial fractures in 2017, percentage change in YLDs of facial fractures, and the EAPC in age-standardized YLDs rate of facial fractures between 1990 and 2017 among 195 countries or territories. Warm color tone presents high level while cold tone presents a lower level. The top three locations with the highest ASR-YLDs, percentage change in years lived with facial fractures and EAPC in ASR-YLDs are marked in the maps respectively. YLDs, years lived with disability; EAPC, estimated annual percentage change; ASR, age-standardized rate.

Figure 8. The proportion of different age groups in facial fractures by years between 1990 and 2017.

(A) Incidence. (B) Prevalence. (C) Years lived with disability. Each color presents specific age group. The age distribution of facial fracture alters with the years advancing from 1990 to 2017.

Figure 9. The rate of facial fractures between males and females among different age groups in 1990 and 2017.

(A) Incidence rate. (B) Prevalence rate. (C) Years lived with disability rate. Blue bar indicates males and red bar indicates females. X-axis presents rates of facial fractures and Y-axis presents different age brackets. Left column presents rates of facial fractures in 1990 while the right presents in 2017. Incidence rate shows doublets in males and singlet in females in 1990 and 2017. Prevalence rate and years lived with disability rate of facial fractures increase with aging. YLDs, years lived with disability.

Figure 10. The trends of age standardized rate of facial fractures in global and Syria by gender from 1990 to 2017.

(A) Global. (B) Syria. Each color presents specific ASR that pink indicates ASIR, dark blue the ASPR and pale blue the age-standardized YLDs rate. X-axis presents ASRs in females (left) and males (right), and Y-axis the different years. The ratio of males: females tends to be approximately 2:1 worldwide and facial fractures in Syria showed an upsurge in 2011. ASR, age-standardized rate; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability.