Changes in the Incidence of Eye Trauma Hospitalizations in the United States from 2001 Through 2014

Importance: Eye trauma is a common cause of vision loss and a substantial public health problem. Objective: To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis. Design, Setting, and Participants: This retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge. Exposures: Eye trauma. Main Outcomes and Measures: Incidence and characteristics of inpatient primary and secondary eye trauma. Results: From 2001 to 2014, there were an estimated 939608 inpatient admissions (of whom 556886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100000 population; P =.001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100000 population; P =.004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64149 [39.9%]) for primary trauma and contusion of eye and adnexa (19301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI, 1.19-1.32]) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101796 [63.4%]; secondary diagnosis: 274538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51212 [31.9%]; secondary diagnosis: 166260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20929 [2.7%]). Conclusions and Relevance: These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective preventive strategies. Many of these patients are seen in ophthalmology practices where proactive risk assessment and counseling can play a critical role.