Epidemiologic Pattern and Injury Mechanism of Intimate Partner Violence–Related Ocular Trauma in the US

Abstract

ImportanceIntimate partner violence (IPV) is an important cause of death and disability worldwide. The literature estimates that 45% of IPV injuries involve the eyes. Many medical fields have increased IPV-related research; however, ophthalmology IPV research remains rare.ObjectiveTo evaluate the epidemiologic pattern and injury mechanism of IPV related to ocular trauma.Design, Setting, and ParticipantsThis study was a retrospective cross-sectional analysis with deidentified data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes from the National Trauma Data Bank (NTDB), which is a data set collected by the American College of Surgeons. The NTDB is the largest US hospitalized trauma case database with submissions from more than 900 US facilities. Included in this analysis were the IPV-related ocular injuries of patients hospitalized between 2017 and 2019. Study data were analyzed from April 20 to October 15, 2022.ExposuresIPV-related ocular injuries.Main Outcomes and MeasuresOcular injuries and adult IPV trauma survivors were identified with the ICD-10-CM codes. The following demographic data were collected: sex, age, race and ethnicity, health insurance plan, substance misuse screening results, trauma level of hospital, the emergency department disposition, the total Glasgow Coma Scale score, the abbreviated injury scale, and caregiver at discharge.ResultsA total of 2598 of the recorded ocular injuries were associated with IPV. Patients had a mean (SD) age of 45.2 (18.4) years, and 1618 were female (62.3%). Most patients in the population sample (1195 [46.0%]) were aged 18 to 39 years. The race and ethnicity distribution was as follows: 629 Black (24.2%), 296 Hispanic (11.4%), 1358 White (52.3%), 229 other (8.8%), and 86 missing (3.3%). Insurance statuses were Medicaid (847 [32.6%]), Medicare (524 [20.2%]), private insurance (524 [20.2%]), and self-pay (488 [18.8%]). Women had greater odds of testing positive during alcohol screening (odds ratio [OR], 1.42; 95% CI, 1.21-1.67; P < .001). Black patients were most likely to have Medicaid (OR, 1.64; 95% CI, 1.35-1.99; P < .001), Hispanic patients were most likely to self-pay (OR, 1.96, 95% CI, 1.48-2.58; P < .001), and White patients were most likely to use Medicare (OR, 2.94, 95% CI, 2.33-3.73; P < .001).Conclusions and RelevanceSocial determinants of health were identified as key risk factors for IPV-related ocular injuries. Study findings highlight identifiable risk factors associated with IPV and ocular trauma that can contribute to IPV awareness among ophthalmologists.

Intimate Partner Violence and the Role of Ophthalmology

“…Socioeconomic indicators of health are often associated with injury rates. Access to economic resources and income levels were key risk factors for IPV reported by Alik et al 3 The relative risk of IPV was higher in persons with Medicaid and for female individuals or those with Black racial background. However, the racial background of patients with injuries overall was approximately 50% White and 25% Black.…”

“…1 Alcohol is often associated with ocular trauma, with 30% of trauma cases at a regional hospital in Australia involving alcohol; this figure is rising to 76% in assault-related cases and 85.2% for Indigenous Australians. 6 Alik et al 3 found that female individuals were at greater odds of alcohol use, with 42.5% screening positive for alcohol use, but had negative drug screens.…”

“…In the current article, 3 the majority of injuries were orbital fractures (37.1%) followed by contusion of the eyelid or periocular eyelid (25.8%). Orbital fractures were associated with a severe (≤8) Glasgow Coma Score.…”

“…A review of 48 population-based studies in 2017 identified that 45% injuries from intimate partner violence (IPV) involve the eyes . In this issue of JAMA Ophthalmology , Alik et al ask the question, “What is the epidemiological pattern of IPV-related ocular injury in the adult population of the US?” Their analysis identifies important risk factors including sex, race and ethnicity, and socioeconomic level, which are distinctly different from other causes of ocular injury. Ophthalmology may play an important role, beyond treatment of the injury, to help identify IPV and enable prevention strategies.…”