Men from Scotland’s poorest areas are nearly seven times more likely to suffer major alcohol-related facial injuries than their more affluent counterparts, according to University of Glasgow academics.

In a paper published online in the Journal of Trauma, Dr David Conway, Dr Christine Goodall and Dr Alex McMahon, of the University’s Dental School, report that poverty is the major determinant of severe facial injuries and that young men from low socio-economic backgrounds are among the most at risk in society.

In ‘The Scar on the Face of Scotland: Deprivation and Alcohol-Related Facial Injuries in Scotland’, Dr Goodall and her co-authors examine the influences behind alcohol-related facial injuries. Dr Goodall, a Senior Clinical Lecturer in Oral Surgery, said: "We already know that injuries to the face and neck are most commonly sustained as a result of interpersonal violence. While we found that, overall, there has been a small decrease in the numbers of alcohol related injuries the nature and scale of the problem remains considerable. Furthermore, the major burden of these injuries disproportionately affects young men from socio-economically deprived areas."

According to the report, between 2001 and 2006, there were 82,461 patients in a severe enough condition to be admitted to Scottish hospitals with a facial injury diagnosis. Of those, 22,417 or 27.2 per cent had a concomitant alcohol-related diagnosis.

During the same period, the overall incidence of facial injuries was 3.27 per 1000 Scots.

For men, the figure is twice as high as for women. The experts found that in men the overall incidence of facial injury is 4.68 per 1000 people, while it is 2 per 1000 for females.

The incidence of alcohol-related facial injuries in the same period was 0.89 per 1000 population - 1.54 per 1000 Scots for males and in women 0.30 per 1000 people.

The paper cites that the annual cost of alcohol misuse to Scottish society, is an estimated £2.25 billion, with the cost to the National Health Service in Scotland estimated at £405 million.

Dr Conway, a Senior Clinical Lecturer in Dental Public Health at the Dental School, continued: "The costs to society and the health service are high, but the cost to individuals health is great. Facial injuries produce significant and nasty facial scars – but the fact that this is determined by your postcode and how deprived the area you live in is a societal scar for all of us."

"Those from the most deprived areas were almost seven times more likely to have such an injury as their affluent counterparts. Men were over five times more likely to have such an injury, and those in the youngest age-group, 15–19 years, were around one-tenth more likely."

Dr Goodall added: "Our data is in agreement with the Scottish Crime and Victimisation Survey which observed a decline between 1992 and 2005 in "serious assaults". A serious assault is defined as that which leads to an overnight stay in hospital or internal injuries, severe concussion, loss of consciousness, lacerations, or other injury that could lead to impairment or disfigurement. Although there is a significant increase in "minor assaults" - that is an actual and attempted assault which lead to no or negligible injuries."

The paper also highlights a recent case-series of 249 patients from a Scottish trauma unit which found that around 80 per cent of their facial injuries were alcohol-related and more than 70 per cent of those injuries were as a result of interpersonal violence. In addition, the Scottish Emergency Department Audit estimated the number of assault-related facial injuries presenting to A&E departments around Scotland in 2006 at 11,986 per year. Of these, 70 per cent were estimated to be alcohol-related. Both of these studies include patients with less serious injuries who were not admitted to hospital.

However, the authors conclude that “our findings could be an underestimate of the true incidence of alcohol-related facial injuries” as the data refer only to inpatients.

Dr Goodall said that one way to address the high incidence of alcohol-related facial injuries could be by the use of  brief interventions on safer drinking when patients attend A&E or facial trauma clinics. 

"We know from previous work in Glasgow that 25% of facial trauma patients will sustain another alcohol related injury in the future. Brief alcohol counselling sessions have been shown to be effective in helping facial  trauma patients to cut down their drinking both by ourselves and by other groups around the country. The aim would be to prevent a further alcohol related injury."

Dr Conway goes further and would "advocate for major change to tackle socioeconomic inequalities in society".

The authors argue that on a wider level there needs to be more explicit targeting of younger men, particularly those living in areas of deprivation, to confront the acute adverse health problems associated with excessive alcohol intake.

"Interventions to change behaviour alone are unlikely to succeed unless they are supported by measures designed to improve socioeconomic circumstances and to reduce socioeconomic inequalities. Health professionals also have a role here and need to consider advocating for socioeconomic change in addition to behaviour change.

"Health inequalities related to deprivation alcohol and interpersonal violence are recognized as serious cultural and societal problems in Scotland. There is a need to coordinate these agenda to address socioeconomically determined alcohol-related injuries informed by robust information," said Dr Conway. 

For more media information please contact Eleanor Cowie, Media Relations Officer at the University of Glasgow, on Telephone: 0141 330 3683 or Email: e.cowie@admin.gla.ac.uk

First published: 19 November 2009

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