The global incident cases of facial fractures increased from 8.9 million cases (95% UI: 7.1 million to 11.4 million cases) in 1990 to 10.7 million cases (95% UI: 8.5 million to 13.5 million cases) in 2019, corresponding to an increase of 19% (95% UI: 10–26%). However, the global ASIR of facial fractures decreased from 161.5 (95% UI: 128.8 to 204.8) per 100,000 in 1990 to 138.8 (95% UI: 110.6 to 174.8) per 100,000 in 2019 with an EAPC of − 0.47 (95% UI: −0.57 to − 0.37).

In 2019, the ASIR across the 204 countries was highest in New Zealand (464.2 per 100,000, 95% UI: 350.1 to 620.6 per 100,000), followed by Slovenia (401.1 per 100,000, 95% UI: 303.1 to 538.4 per 100,000), Australia (400.2 per 100,000, 95% UI: 295.7 to 539.4 per 100,000), while lowest in Democratic People’s Republic of Korea (59.2 per 100,000, 95% UI: 47.2 to 73.8 per 100,000) (Fig. 1A, Supplementary Table S1). The EAPC in the incidence was highest in the Syrian Arab Republic (8.19, 95% UI: 5.25 to 11.22) and Central African Republic (3.80, 95% UI: 2.09 to 5.54), while lowest in Liberia (-6.33, 95% UI: -8.85 to -3.74) and Burundi (-5.83, 95% UI: -9.48 to -2.04) (Fig. 1B).

ASR and EAPC of facial fractures in 204 countries and territories. The ASIR (A), ASPR (C), and ASYR (E) in 2019. The EAPC in ASIR (B), ASPR (D), and ASYR (F) from 1990 to 2019. ASR, age-standardized rate; EAPC, estimated annual percentage changes; YLDs, years lived with disability; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASYR, age-standardized YLDs rate

In terms of geographic regions, the number of incident cases has increased in most regions, except Eastern Europe (-32%, 95% UI: -34% to -29%), Central Europe (-29%, 95% UI: -32% to -26%), Eastern Sub-Saharan Africa (-26%, 95% UI: -63% to -34%), High-income Asia Pacific (-17%, 95% UI: -21% to -14%), and Western Europe (-17%, 95% UI: -21% to -14%) (Supplementary Table S2, Fig. 2A). In 2019, the ASIR was the highest in Australasia (410.1 per 100,000, 95% UI: 304.4 to 552.8 per 100,000) and the lowest in Central Sub-Saharan Africa (80.3 per 100,000, 95% UI: 63.7 to 100.3 per 100,000). The ASIR showed a decreasing trend in most regions from 1990 to 2019, except North Africa and Middle East (EAPC, 1.04, 95% UI: 0.61 to 1.47) and Caribbean (EAPC, 0.54, 95% UI: -0.35 to 1.43) (Supplementary Table S2).

The incidence of facial fractures. (A) The number of incident cases between 1990 and 2019 in 21 regions; (B) the association between ASIR and SDI in 21 regions; (C) changes in incident cases in different SDI regions from 1990 to 2019; (D) trends in ASIR in different SDI regions from 1990 to 2019; (E) the ASIR of different age group in 2019; (F) the ASIR in both sexes from 1990 to 2019. ASIR, age-standardized incidence rate; SDI, sociodemographic index

There was a significant positive correlation between ASIR and SDI (ρ = 0.58, p < 0.001) (Fig. 2B). The number of incident cases showed an increasing trend from 1990 to 2019 in all SDI regions except high-middle SDI region (-6%, 95% UI: -10% to -1%) (Fig. 2C). The middle SDI region had the largest incident cases in 1990 (2.1 million, 95% UI: 1.6 million to 2.6 million) and 2019 (2.7 million, 95% UI: 2.2 million to 3.4 million). The high SDI region held the highest ASIR both in 1990 (219.8, 95% UI: 167.8 to 287.3 per 100,000) and in 2019 (199.6, 95% UI: 150.6 to 260.9 per 100,000) (Fig. 2D). The ASIR decreased in all SDI regions from 1990 to 2019 except middle SDI region (EAPC, 0.31, 95% UI: 0.17 to 0.45). In 2019, the ASIR of facial fractures varied among the different age groups, reaching a peak in the 20–24 years age group in males and 10–14 years age group in females (Fig. 2E). Further, there was a gradual increase in incidence rate with age higher than 70 years old. The ASIR was higher in males than in females from 1990 to 2019 (Fig. 2F). Specifically, there were 216.6 per 100,000 males versus 104.7 per 100,000 females in 1990, while 183.4 per 100,000 males versus 93.0 per 100,000 females in 2019.

The global prevalent cases of facial fractures increased from 1.5 million cases (95% UI: 1.2 million to 1.8 million cases) in 1990 to 2.1 million cases (95% UI: 1.8 million to 2.5 million cases) in 2019, corresponding to an increase of 42% (95% UI: 34–48%). However, the global ASPR of facial fractures decreased from 30.1 (95% UI: 25.4 to 36.0) per 100,000 in 1990 to 27.1 (95% UI: 23.0 to 31.9) per 100,000 in 2019 with an EAPC of − 0.39 (95% UI: −0.46 to − 0.31).

In 2019, the ASPR across the 204 countries was highest in Afghanistan (83.7 per 100,000, 95% UI: 36.3 to 198.1 per 100,000), followed by New Zealand, Slovenia, while lowest in Democratic People’s Republic of Korea (11.4 per 100,000, 95% UI: 9.7 to 13.3 per 100,000) (Fig. 1C, Supplementary Table S1). The EAPC in the prevalence was highest in the Syrian Arab Republic (7.49, 95% UI: 5.07 to 9.96) and Central African Republic (3.27, 95% UI: 2.02 to 4.54), while lowest in Liberia (-3.59, 95% UI: -5.21 to -1.94) and Angola (-2.41, 95% UI: -3.39 to -1.43) (Fig. 1D).

In terms of geographic regions, the number of prevalent cases has increased in most regions, except Central Europe (-63%, 95% UI: -73% to -53%), Eastern Europe (-22%, 95% UI: -24% to -19%), and Eastern Sub-Saharan Africa (-1%, 95% UI: -46–55%) (Supplementary Table S2, Fig. 3A). In 2019, the ASPR was the highest in Australasia (63.6 per 100,000, 95% UI: 51.0 to 82.0 per 100,000) and the lowest in Western Sub-Saharan Africa (16.7 per 100,000, 95% UI: 14.1 to 19.7 per 100,000). The ASPR showed decreasing trend in most regions from 1990 to 2019, except Caribbean (EAPC, 0.75, 95% UI: 0.12 to 1.39), North Africa and Middle East (EAPC, 0.42, 95% UI: 0.14 to 0.71), Oceania (EAPC, 0.33, 95% UI: 0.06 to 0.59), South Asia (EAPC, 0.16, 95% UI: 0 to 0.31), Western Sub-Saharan Africa (EAPC, 0.09, 95% UI: -0.06 to 0.25), and Central Latin America (EAPC, 0.02, 95% UI: -0.21 to 0.25) (Supplementary Table S2).

The prevalence of facial fractures. (A) The number of prevalent cases between 1990 and 2019 in 21 regions; (B) the association between ASPR and SDI in 21 regions; (C) changes in prevalent cases in different SDI regions from 1990 to 2019; (D) trends in ASPR in different SDI regions from 1990 to 2019; (E) the ASPR of different age group in 2019; (F) the ASPR in both sexes from 1990 to 2019. ASPR, age-standardized prevalence rate; SDI, sociodemographic index

There was a significant positive correlation between ASPR and SDI (ρ = 0.54, p < 0.001) (Fig. 3B). The number of prevalent cases showed an increasing trend from 1990 to 2019 in all SDI regions (Fig. 3C). The high SDI region held the highest ASPR both in 1990 (37.8, 95% UI: 31.2 to 46.5 per 100,000) and in 2019 (34.7, 95% UI: 28.6 to 42.8 per 100,000) (Fig. 3D). The ASPR decreased in all SDI regions from 1990 to 2019 except middle SDI region (EAPC, 0.18, 95% UI: 0.06 to 0.30). In 2019, the ASPR of facial fractures increased with age (Fig. 3E). The ASPR was higher in males than in females from 1990 to 2019 (Fig. 3F). Specifically, there were 39.5 per 100,000 males versus 20.7 per 100,000 females in 1990, while 35.0 per 100,000 males versus 19.1 per 100,000 females in 2019.

The global YLDs of facial fractures increased from 98.1 thousand years (95% UI: 58.5 thousand to 145.8 thousand years) in 1990 to 137.6 thousand years (95% UI: 84.3 thousand to 201.4 thousand years) in 2019, corresponding to an increase of 40% (95% UI: 32–47%). However, the global ASYR of facial fractures decreased from 2.0 (95% UI: 1.2 to 2.9) per 100,000 in 1990 to 1.8 (95% UI: 1.1 to 2.6) per 100,000 in 2019 with an EAPC of − 0.39 (95% UI: −0.47 to − 0.32).

In 2019, the ASYR across the 204 countries was highest in Afghanistan (5.2 per 100,000, 95% UI: 2.1 to 11.5 per 100,000), followed by New Zealand, Slovenia, while lowest in Democratic People’s Republic of Korea (0.7 per 100,000, 95% UI: 0.5 to 1.1 per 100,000) (Fig. 1E, Supplementary Table S1). The EAPC in the YLDs was highest in the Syrian Arab Republic (7.48, 95% UI: 5.05 to 9.96) and Central African Republic (3.29, 95% UI: 2.02 to 4.58), while lowest in Liberia (-3.74, 95% UI: -5.41 to -2.04) and Eritrea (-3.19, 95% UI: -4.42 to -1.93) (Fig. 1F).

In terms of geographic regions, the number of YLDs has increased in most regions, except Eastern Sub-Saharan Africa (-2%, 95% UI: -46% to -55%), Central Europe (-16%, 95% UI: -20% to -11%), and Eastern Europe (-22%, 95% UI: -25–19%) (Supplementary Table S2, Fig. 4A). In 2019, the ASYR was the highest in Australasia (4.2 per 100,000, 95% UI: 2.4 to 6.3 per 100,000) and the lowest in Western Sub-Saharan Africa (1.1 per 100,000, 95% UI: 0.7 to 1.6 per 100,000). The ASYR showed a decreasing trend in most regions from 1990 to 2019, except Caribbean (EAPC, 0.72, 95% UI: 0.08 to 1.38), North Africa, and Middle East (EAPC, 0.46, 95% UI: 0.17 to 0.76), Oceania (EAPC, 0.31, 95% UI: 0.03 to 0.58), South Asia (EAPC, 0.15, 95% UI: 0.01 to 0.30), Western Sub-Saharan Africa (EAPC, 0.09, 95% UI: -0.07 to 0.25), and Central Latin America (EAPC, 0.03, 95% UI: -0.20 to 0.26) (Supplementary Table S2).

The YLDs of facial fractures. (A) The number of YLDs between 1990 and 2019 in 21 regions; (B) the association between ASYRand SDI in 21 regions; (C) changes in YLDs in different SDI regions from 1990 to 2019; (D) trends in ASYRin different SDI regions from 1990 to 2019; (E) the ASYRof different age group in 2019; (F) the ASYRin both sexes from 1990 to 2019. ASYR, age-standardized YLDs rate; SDI, sociodemographic index; YLDs, years lived with disability

There was a significant positive correlation between ASYR and SDI (ρ = 0.54, p < 0.001) (Fig. 4B). The number of YLDs showed an increasing trend from 1990 to 2019 in all SDI regions (Fig. 4C). The high SDI region held the highest ASYR both in 1990 (2.5, 95% UI: 1.5 to 3.7 per 100,000) and in 2019 (2.3, 95% UI: 1.3 to 3.4 per 100,000) (Fig. 4D). The ASYR decreased in all SDI regions from 1990 to 2019 except middle SDI region (EAPC, 0.18, 95% UI: 0.07 to 0.30). In 2019, the ASYR of facial fractures increased with age (Fig. 4E). The ASYR was higher in males than in females from 1990 to 2019 (Fig. 4F). Specifically, there were 2.6 per 100,000 males versus 1.3 per 100,000 females in 1990, while 2.3 per 100,000 males versus 1.2 per 100,000 females in 2019.

The five leading causes for the incidence, prevalence, and YLDs of facial fractures included falls, road injuries, exposure to mechanical forces, interpersonal violence, and other unintentional injuries (Fig. 5). Falls were the leading cause of facial fractures, with an ASIR of 48.2 (95% UI: 27.3 to 77.4) per 100,000 in 2019, an ASPR of 9.90 (95% UI: 7.7 to 13.3) per 100,000, and an ASYR of 0.6 (95% UI: 0.4 to 1.0) per 100,000 in 2019, despite the decreasing trends from 1990 to 2019 (Fig. 5A, C and E). Road injuries served as the second highest ASIR of 26.3 (95% UI: 16.1 to 40.8) per 100,000, ASPR of 6.5 (95% UI: 5.3 to 8.2) per 100,000, and ASYR of 6.5 (95% UI: 5.3 to 8.2) per 100,000 in 2019, showing the increasing trends from 1990 to 2019 (Fig. 5A, C and E).

The causes of facial fractures. The cause composition of the ASIR (A), ASPR (C), and ASYR (E) of facial fractures between 1990 and 2019. The top five causes for the incidence (B), prevalence (D), and YLDs (F) of facial fractures in different age groups in 2019. YLDs, years lived with disability; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASYR, age-standardized YLDs rate

In different age groups, facial fractures due to falls remained at a high ASIR at younger ages and rapidly increased at older ages (Fig. 5B). The incidence rate of facial fractures due to road injuries peaked at ages 20–24 and then decreased with age (Fig. 5B). The ASPR and ASYR of facial fractures due to falls steadily increased with age, while the ASPR and ASYR due to road injuries peaked at older ages (Fig. 5D and F).

In terms of the main causes for the incidence, prevalence, and YLDs of facial fractures, the ASIR, ASPR, and ASYR were higher in men than in women (Supplementary Figure S1A, S1C, S1E). For the facial fractures caused by falls, the ASIR, ASPR, and ASYR were higher in young men than in young women, while those in older women over 70 years old were higher than those in older men (Supplementary Figure S1B, S1D, S1F).