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. Author manuscript; available in PMC: 2026 Jul 1.
Published in final edited form as: Am J Ophthalmol. 2025 Sep 11;281:223–232. doi: 10.1016/j.ajo.2025.09.013

Ocular and Orbital Trauma Correlated With an Increased Risk of Mortality in Female Patients With a History of Intimate Partner Violence

LINUS AMARIKWA 1, LYNETTE M RENNER 1, NATALIE A HOMER 1, KAREN M WAI 1, CHASE A LUDWIG 1, EUNA KOO 1, EHSAN RAHIMY 1, PRITHVI MRUTHYUNJAYA 1, ERIN M SHRIVER 1, ANDREA L KOSSLER 1
PMCID: PMC13318399  NIHMSID: NIHMS2190013  PMID: 40945888

Abstract

OBJECTIVE:

To characterize the risk factors for mortality and rates of mortality in female patients with a history of ocular or orbital trauma and intimate partner violence (IPV).

DESIGN:

This is a retrospective cohort study that included all data from 2005 to 2024.

PARTICIPANTS:

Included females aged 18 to 55 years old with variable history of IPV and orbital trauma.

METHODS:

Patients were identified using the TriNetX Network and were grouped by presence of IPV and orbital trauma. Rates of mortality, hospitalization, and emergency department visits following trauma were analyzed. Propensity score matching was done to control for differences in baseline demographics and medical comorbidities. Cox regression analysis was completed to determine the association between mortality and known risk factors for IPV.

MAIN OUTCOME MEASURES:

Hazard ratio for mortality and rate of 5-year mortality following ocular or orbital trauma.

RESULTS:

After matching and assessing for the presence of ocular or orbital trauma, 2812 patients were included in both the IPV-related ocular or orbital trauma and IPV with no ocular or orbital trauma groups. The analysis found that a history of ocular or orbital trauma increased the risk of mortality in patients with a history of IPV (hazard ratio = 1.7, 95% CI: 1.3–2.4, P < .001).

CONCLUSIONS:

A history of ocular or orbital trauma is a significant risk factor for mortality among female patients with a history of IPV. High-risk patients should be identified at the time of presentation and protective measures initiated.

INTRODUCTION

Intimate partner violence (IPV) refers to physical violence, sexual violence, stalking, or psychological aggression that is committed by a current or former spouse or dating partners.1 Consequences of IPV may include facial trauma, post-traumatic stress disorder, mood disorders, maladaptive behaviors, sexually transmitted infections, concern for safety, and missing work or school. In more severe cases, IPV may result in severe injury, lifelong disability, or death. A 2016 Centers for Disease Control survey found that an estimated 9 million females in the United States (US) experience IPV every year.2 Of the female respondents with a history of IPV, 69% experienced severe physical violence which included blunt trauma, asphyxiation, thermal injury, knife violence, or gun violence.3 Familiarity with IPV is critical for ophthalmologists because the most common location of IPV-related injury is the face, which is affected in 68% of cases.4 The eyes and skull are affected in 45% and 48% of cases, respectively.4–6

Ocular trauma among women who experienced IPV has been previously investigated by a few scholars.7–9 Although ocular injuries are not as common as orbital traumas in this patient population, ocular injury tends to be more severe. IPV is also often missed in these cases. Cohen et al8 found that 80% of IPV-related ocular injuries resulted in enucleation. Orbital trauma is relatively common in patients with a history of IPV and IPV has been found to be the third most common cause of orbital traumas.10 The most common types of fractures include zygomaticomaxillary complex fractures, orbital floor, and medial wall fractures.10 Notably, patients with IPV-related orbital trauma often present with fractures in multiple stages of healing from prior episodes.11 The leading causes of IPV-related orbital fractures include blunt trauma due to fists or other readily available household objects, and being slammed against a hard surface like a wall.12 Given the severe nature of these injuries and the potential consequences, it is alarming that documentation of patient safety and referral to ancillary services is not frequently performed.10

IPV is one of the leading causes of homicide in the US, implicated in 55% of female homicides.13 Adult females of child-bearing age are most at risk of IPV-related mortality.14 Rates of IPV drop greatly after the age of 55.14–17 In 11.2% of IPV-related homicide cases, the deceased experienced violence in the month preceding their death, which could allow healthcare and social service providers opportunities to intervene and potentially have a life-saving impact.13 Data on IPV-related homicides have prompted improvements in the screening and interventions used in IPVs.18 The US Preventative Services Task Force recommends screening for IPV and referring to ancillary services that include counseling, home visits, risk factor mitigation, and parenting support.19 However, it is unclear whether these strategies should be employed universally or in a targeted fashion. To date, randomized control trials evaluating the efficacy of screening and intervention in IPV have found that screening effectively identifies patients with a history IPVs. Though, referral to ancillary services has not conclusively improved outcomes like recurrence of IPV, quality of life, or severity of injuries.18–20 The lack of interventions that improve outcomes in IPV is likely multifactorial.21–24 It is possible that more focus on outcomes like mortality and improved methods of assessing quality of life may yield different results.25 A recent meta-analysis of trauma centers and emergency department (ED) IPV screening studies found that none of the studies assessed for mortality.26

Patients with a history of IPV are often affected for several years prior to presenting to a healthcare provider.27 To develop better practices for treating patients with IPV and orbital trauma, improved assessment of IPV outcomes is needed, with a particular focus on stronger follow-up and inclusion of mortality as an outcome. Here we report on the mortality rate, hospitalization rate, rate of ED visits, and risk factors for mortality in a large cohort of female patients with a history of IPV and orbital trauma.

METHODS

This is a retrospective cohort study using patient records acquired from the TriNetX network (Cambridge, MA, USA), an aggregated electronic health records database that collates deidentified patient data from 66 healthcare organizations. TriNetX adheres to the Health Insurance Portability and Accountability Act (HIPAA) and is certified to the ISO 27001:2013 standard. This study was not humans subjects research, and IRB approval was not required.

Data were collected from the TriNetX database on 10/15/24 and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines when reporting results. All records from 01/01/2005 to 10/15/2024 were included in the analysis. At the time of query, there were approximately 59,000,000 female patients in the database. Patients were included in the analysis if they were females between the ages of 18 and 55. IPV was defined using the following ICD-10 codes (ICD-10: T74.1, T74.2, T74.3, Z63.0, Z69.1, Z91.410) as these were found to increase the diagnostic accuracy of detecting IPV in a recent retrospective analysis.28 Ocular and orbital trauma (ICD-10: S00.1, S01.1, S02.1, S02.3, S02.4, S02.8, S05, T15, T26) was evaluated if the trauma occurred within 1 year of IPV documentation.

This sample was then split into several groups. Group 1 had a history of IPV and ocular or orbital trauma. Group 2 had a history of IPV but no ocular or orbital trauma. Group 3 had a history of ocular or orbital trauma but no history of IPVs. A control group was also created with females who had no history of ocular or orbital trauma and no history of IPVs.

The primary outcome was the hazard ratio (HR) for mortality and rate of 5-year mortality following ocular or orbital trauma. Secondary outcomes included the rate and relative risk (RR) of hospitalization, rate and RR of an ED visit within 5 years of the initial ocular or orbital event. A Cox proportional hazards model was used to evaluate the effect of multiple variables on survival in patients with a history of IPV and ocular or orbital trauma (Group 1). Propensity score matching (PSM) was used to match patients according to age, race, ethnicity, psychological/personality disorder, substance abuse, socioeconomic status, and medical comorbidities, as these are factors that have been associated with increased mortality in females.29–32 Race categories included: White, Black, Asian, and Other. Other races included American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and unknown. Medical comorbidities that are associated with mortality in young females include the presence of neoplasms (C00-D49), cardiac arrhythmias (I49), ischemic heart disease (I20-I25), and cardiomyopathy (I42), as these are the most common medical causes of mortality in the study population.33 Socioeconomic status was assessed using a broad group of ICD-10 codes Z55-Z65. These codes broadly document exposure to factors that are associated with socioeconomic factors that have been found to increase risk of IPV like education, literacy, employment status, physical environment, housing status, economic circumstances, social environment, and lack of support group.

Five comparisons were made: Group 1 vs Group 2, Group 1 vs Group 3, Group 1 vs control, Group 2 vs control, and Group 3 vs control. All primary and secondary outcomes were reported after PSM. If groups had significant differences after PSM, these were noted in the results. Otherwise, all groups had no significant differences after PSM. PSM was performed using the TriNetx built-in analysis platform (1:1 matching by nearest neighbor greedy matching algorithm). Significance tests were 2-sided and paired. A significance threshold of P < .05 was used, and 95% CIs were calculated. Specific p-values were not reported in TriNetX, but CIs are reported. CIs that do not include the number 1 are statistically significant. Descriptive statistics, including mean, SD, counts, and percentages, were used to describe demographic variables. The functions within TriNetX were used to calculate these statistics.

RESULTS

A total of 28,097,438 female patients between the ages of 18 and 55 were considered for inclusion in the analysis. Group 1 included 2812 patients who had a history of IPV and ocular or orbital trauma. Group 2 included 122,355 patients who had a history of IPV but no ocular or orbital trauma. Group 3 included 317,753 patients who had a history of ocular or orbital trauma but no history of IPVs. The control group included 9674,202 patients who had no history of ocular or orbital trauma and no history of IPVs.

The mean age and SD for Groups 1 to 3 and the control group were 31.1 (10.5), 31.0 (10.5), 31.3 (10.7), 31.2 (10.6), respectively. Overall, 52% of patients were documented as White, 15% were documented as Black, 4% were documented as Asian, and 20% were documented as having an unknown or other race. Hispanic ethnicity was documented in 12% of patients.

The frequency of IPV-related ICD codes and ocular or orbital trauma ICD codes were assessed. Of the patients with a history of IPV, 49% had a history of adult physical or sexual abuse (Z91.410), 22% had a history of sexual abuse (T74.2), 14% had a history of physical abuse (T74.1), 11% had problems in their relationship (Z63.0), 4% had a history of psychological abuse (T74.3), and <1% sought mental health services for partner abuse (Z69.1). Of the patients with a history of ocular or orbital trauma, 46% had a history of fractured orbital or facial bones, 20% had a history of unspecified injury to the eye or orbit, 18% had a history of contusion to the globe or periocular area, 8% had a history of foreign body on the eye, 8% had a history of open wound of the ocular/periocular area, 1% or fewer patients had a history of laceration of the globe, burn, or open globe injury.

Group 1 (IPV and ocular or orbital trauma) vs Group 2 (IPV and no ocular or orbital trauma).

Patients in Group 1 had a significantly higher 5-year mortality rate than patients in Group 2 (4% vs 2%; HR = 1.7, 95% CI: 1.3–2.4) (Table 2). Hospitalization (35% vs 31%, RR = 1.1, 95% CI: 1.0–1.2) and an ED visit (60% vs 47%, RR = 1.3, 95% CI: 1.2–1.4) were also both significantly more common in Group 1.

TABLE 2.

Hazard/Risk Ratios for Rates of Mortality, Hospitalization, and ED Visits

Mortality Hospitalization ED Visits
Group 1 vs Group 2 1.74 (1.27–2.37)a 1.12 (1.04–1.21)a 1.28 (1.22–1.35)a
Group 1 vs Group 3 2.10 (1.52–2.90)a 1.78 (1.64–1.95)a 1.22 (1.16–1.29)a
Group 1 vs Control 2.60 (1.81–3.73)a 2.54 (2.29–2.82)a 1.26 (1.20–1.33)a
Group 2 vs Control 1.54 (1.42–1.68)a 2.59 (2.52–2.65)a 1.17 (1.16–1.18)a
Group 3 vs Control 1.25 (1.17–1.33)a 1.53 (1.50–1.56)a 1.12 (1.11–1.13)a
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Mortality column demonstrates hazard ratio and 95% CI for mortality, hospitalization and ED visit columns demonstrate relative risk and 95% CI of outcomes, reference group in each comparison is bolded.

Group 1 = IPV and ocular or orbital trauma; Group 2 = IPV and no ocular or orbital trauma; Group 3 = ocular or orbital trauma with no IPV; IPV = intimate partner violence.

a

Indicates significant results.

When comparing pre-PSM risk factors between Group 1 and Group 2, patients in Group 1 had a higher prevalence of several risk factors associated with higher mortality including a history of health hazards related to socioeconomic and psychosocial circumstances (34% vs 12%, P = .687), severe stress and adjustment disorders (35% vs 17%, P = .931), substance use disorders (21% vs 6%, P = .687), neoplasms (14% vs 9%, P = .691), arrhythmias (13% vs 4%, P = .651), ischemic heart disease (3% vs 1%, P = .006) and cardiomyopathy (2% vs 1%, P = .188). After PSM, 2671 patients were included in both groups, and age, ethnicity, race, psychosocial factors, psychiatric comorbidities, and malignancy were no longer significantly different between groups (Table 1). Notably, Group 1 had a significantly higher rate of ischemic heart disease (3% vs 2%, P = .006) after PSM (Table 1). Mean follow-up was 137 and 127 weeks, in Group 1 and IPV with no ocular or orbital trauma groups, respectively.

TABLE 1.

Baseline Characteristics Across Groups

Group 1 Group 2 Group 3 Control
Age
 Mean (SD) (y) 31.1 (10.5) 31.0 (10.5) 31.3 (10.7) 31.2 (10.6)
Race
 Asian, N (%) 32 (1.2) 31 (1.2) 30 (1.1) 54 (1.9)
 Black, N (%) 693 (25.9) 697 (26.1) 756 (27.0) 744 (26.5)
 White, N (%) 1651 (61.8) 1676 (62.7) 1740 (62.2) 1748 (62.3)
 Unknown race, N (%) 156 (5.8) 143 (5.4) 149 (5.3) 136 (4.8)
 Other, N (%) 139 (5.2) 124 (4.6) 122 (4.4) 126 (4.5)
Ethnicity
 Hispanic, N (%) 360 (13.5) 342 (12.8) 341 (12.2) 299 (10.7)
Comorbidities
 MDD, N (%) 539 (20.2) 544 (20.4) 582 (20.8) 561 (19.9)
 Neoplasms, N (%) 371 (13.9) 361 (13.5) 387 (13.8) 378 (13.5)
 SES 923 (34.5) 937 (35.1) 970 (34.7) 985 (35.1)
 Substance use, N (%) 569 (21.3) 557 (20.8) 583 (20.8) 606 (21.6)
 Arrhythmia, N (%) 344 (12.9) 333 (12.5) 302 (10.8) 57 (2.0)
 Ischemic heart disease, N (%) 92 (3.4) 59 (2.2) 97 (3.5) 57 (2.3)
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Group 1 = IPV and ocular or orbital trauma; Group 2 = IPV and no ocular or orbital trauma; Group 3 = ocular and orbital trauma with no IPV; MDD = major depressive disorder; SES = health factors related to socioeconomic status.

Group 1 (IPV and ocular or orbital trauma) vs Group 3 (ocular or orbital trauma and no IPV).

Patients in Group 1 had a significantly higher 5-year mortality rate than patients in Group 3 (4% vs 2%; HR = 2.1, 95% CI: 1.5–2.9) (Table 2). Hospitalization (36% vs 20%, RR = 1.8, 95% CI: 1.6–2.0) and an ED visit (60% vs 49%, RR = 1.2, 95% CI: 1.2–1.3) were also both significantly more common in Group 1.

Group 1 (IPV and ocular or orbital trauma), Group 2 (IPV and no ocular or orbital trauma), Group 3 (ocular or orbital trauma and no IPV) vs Control Group (no IPV and no ocular or orbital trauma).

Patients in Group 1, Group 2, and Group 3 all had significantly higher 5-year mortality, hospitalizations, and ED visits compared to the control group. Patients in Group 1 had a significantly higher 5-year mortality (4% vs 1%, HR = 2.6, 95% CI: 1.8–3.7), hospitalization (37% vs 14%, RR = 2.5, 95% CI: 2.3–2.8), and an ED visit (60% vs 47%, RR = 1.3, 95% CI: 1.2–1.3) compared to the control group (Fig. 1). Patients in Group 2 had a significantly higher 5-year mortality (0.9% vs 0.7%, HR = 1.3, 95% CI: 1.2–1.3), hospitalization (10% vs 7%, RR = 1.5, 95% CI: 1.5–1.6), and ED visit rate (48% vs 42%, RR = 1.1, 95% CI: 1.11–1.13) compared to the control group. Patients in Group 3 had a significantly higher 5-year mortality (1.7% vs 1.0%, HR = 1.5, 95% CI: 1.4–1.7), hospitalization (26% vs 10%, RR = 2.6, 95% CI: 2.5–2.7), and ED visit rate (54% vs 46%, RR = 1.2, 95% CI: 1.1–1.2) compared to the control group.

FIGURE 1.

FIGURE 1.

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Kaplan–Meier curves comparing mortality outcomes between groups with IPV and ocular or orbital trauma. IPV = intimate partner violence.

RISK FACTORS FOR MORTALITY

Known risk factors for IPV were assessed for their association with mortality among patients in Group 1. Findings from the multivariate analysis indicated that age (HR = 1.0, P < .001), major depressive disorder (HR = 1.4, P < .001), orbital roof fracture (HR = 10.8, P = .004), HIV infection (HR = 1.4, P = .018), viral hepatitis (HR = 1.4, P < .001), having a history of attempted suicide (HR = 1.4, P = .007), documented as White (HR = 1.3, P < .001), having a substance use disorder (HR = 1.6, P < .001), and a history of health hazards related to socioeconomic and psychosocial circumstances (HR = 1.4, P < .001) were associated with a significantly increased risk of mortality. Being married (HR = 0.3, P < .001), never being married (HR = 0.4, P < .001), documented as Black (HR = 0.6, P < .001), and having an unwanted pregnancy (HR = 0.2, P = .006) were associated with a significantly decreased risk of mortality (Fig. 2).

FIGURE 2.

FIGURE 2.

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Cox proportional hazards model demonstrating the effect of multiple variables on survival in patients with a history of intimate partner violence and ocular or orbital trauma. HIV = HIV, SES = history of health hazards related to socioeconomic and psychosocial circumstances; MDD = major depressive disorder; black lines indicate the 95% CI for the hazard ratio of mortality in patients with ocular or orbital trauma (Group 1).

DISCUSSION

Currently, there is a dearth of studies assessing the association between mortality in patients that have experienced ocular or orbital trauma and IPVs. The results demonstrated that female patients who experienced both IPV and ocular or orbital trauma were at an increased risk of mortality compared to female patients with a history of IPV and no ocular or orbital trauma. Fractures of the facial or orbital bones were the most identified injury in patients that experienced IPV, physical/sexual abuse was the most used ICD code to identify patients with IPVs. When assessing risk factors that have been previously associated with IPV, the analysis demonstrated that age, socioeconomic factors, history of MDD, and substance use disorder were significantly associated with increased mortality. Interestingly, females who were documented as Black, reported an unwanted pregnancy, and were either married or never married had decreased mortality rates.

The literature on IPV and ocular trauma has mostly focused on risk factor identification and descriptions of trauma patterns, with limited attention on key outcomes of IPVs. For example, Alik et al34 used the National Trauma Data Bank to assess 2589 IPV-related ocular trauma cases and found that notable risk factors for IPV included being a female and using alcohol. Clark et al10 assessed 5650 facial fractures at one center from 1995 to 2013 and found that IPV-related trauma was the third leading (7.6%) cause of orbital fractures behind falls and motor vehicle collisions. They also found that 20% of cases had no documented etiology, and ascertainment of patient safety was only documented in 1.7% of cases. A follow-up study by Dawoud et al35 at the same institution found that after implementation of improved educational and screening practices, referrals, ascertainment of patient safety, and involvement of law enforcement in IPV increased significantly in adult female patients with IPV-associated orbital fractures. Finally, Teng et al36 evaluated 26,215 cases of IPV-related ocular trauma in the Nationwide ED Sample database from 2008 to 2017. They found that most cases of IPV-related ocular trauma occurred in females and patients in the lowest income quartile. Also, being 60 ≥ years old and having Medicare were significant risk factors for hospital admission. The authors found the mean cost for medical services was $38,540 per encounter and increased with subsequent encounters. Interestingly, they found that 5% of cases were hospitalized vs 33% in the current study. The differences in rates of hospitalization are likely due to differences in the number of patients assessed. Teng et al. had far more patients with IPV-related ocular trauma and likely looked at patients with more mild disease. Overall, these studies demonstrate that IPV and ocular or orbital trauma are serious and costly problems with a much higher prevalence than previously thought. However, none of these studies evaluated mortality, nor did they assess several of the risk factors included in the current study.

Ocular and midface trauma are common in IPV with previous reports documenting involvement of the eyes in 45% of cases.4,5,8,10,37–41 In fact, the presence of midface trauma has been found to be a predictor variable in identifying patients that have experienced IPVs.42–44 This is likely due to the fact that the face is an easy target for blunt trauma with fists and other objects that frequently occur in IPVs.45 Similar to other studies, fractures were the most common form of ocular or orbital injury in this study and the vast majority of patients did not die upon the first encounter of IPVs. Most deaths in the current study occurred years after the initial encounter. The length of time between the identification of IPV and death supports the well-established fact that IPV is a chronic problem that often escalates in frequency and severity over time.46–48 Given the fact that IPV may begin 10 or more years before patients seek out formal support services,49 the association between ocular and orbital trauma and mortality observed in this study indicates that ocular and orbital trauma is a poor prognostic factor and a marker of progressive and severe IPVs. Suicide attempts and death by suicide have been associated with IPV,50,51 and the prevalence of substance use and MDD in this study population suggests that some deaths may have been related to suicide or other means.50,51 Providers who encounter patients with histories of IPV and ocular or orbital trauma should be aware of these dangers and employ best practices that include screening all patients with orbital fracture or ocular injury of unclear etiology in a private and safe location, documenting the assessment of patient safety, and referring suspected IPV patients to appropriate departments and services including social work, IPV advocates, law enforcement, psychiatry, and local shelters.27 IPV advocates should also be part of the care team and available to speak to patients when needed, which may limit time and education barriers to screening for IPVs.52

Notable risk factors for mortality in Group 1 included age, sex, marital status, and a history of substance use. In the analysis, substance use increased the risk of mortality, which may be explained by prior literature which has found that IPV exposure may increase the incidence of risky substance use behaviors like binge drinking, conversion from substance misuse to substance use disorder, and frequency of IPVs.53 Commonly implicated substances include alcohol, cocaine and cannabis, though the mechanism linking IPV victimization and substance use remain unknown.54–56 Black females were found to have a significantly lower mortality rate than other race groups which was surprising because several studies have found that Black patients tend to experience more IPV and have worse health outcomes.2,57,58 Existing literature indicates that Black females face worse outcomes due to limited access to police and legal assistance, despite being more likely to seek emergency services.59–61 The lower reported mortality among Black females observed in our study may result from improper documentation, as up to 13% of IPV-related homicides are inaccurately classified.62–65 This mis-classification may reflect a documented pattern where the IPV concerns of Black females are not taken seriously, leading to underreporting and inadequate identification of IPV-related deaths.59 Further studies are required to confirm these findings. Being married or never being married were found to be protective factors for mortality. These results align with the well-established understanding that separation and divorce increase conflict and the likelihood of mortality; prior studies have found that men are more likely to kill intimate partners when they feel they are being left.66–70

One of the major limitations of EHR-based IPV research is that there is a lack of standardization regarding the use of ICD codes used to identify IPVs.71–74 Also, IPV tends to be underreported by patients and under-recognized by providers. These factors all likely resulted in underreporting of the IPV incidence. Another factor that may have resulted in underreporting of IPV is the profit-based coding that is conducted by most providers. Providers should also consider value-based care when documenting and include factors that may not be related to reimbursement. Assessment of race, ethnicity, and socioeconomic risk factors was also limited, as EHR data lack nuance and are often administratively recorded rather than self-reported. During the COVID-19 pandemic, the incidence and severity of IPV and facial trauma increased.75 Although assessing the impact of the pandemic on the correlation between IPV and ocular and orbital trauma was beyond the scope of this article, future studies should assess how an increase in the incidence of IPV impacts ocular and orbital trauma.

Cases of orbital and ocular trauma were included in the analysis if they occurred within 1 year of IPVs. As a result, some cases of orbital or ocular trauma may not have been related to IPVs. In addition, several of the codes used to identify IPV could possibly have overlapped with general adult abuse. The lack of specificity in the criteria for IPV was addressed by focusing the analysis on a high-risk population, female patients between ages 18 and 55 years. To rule out medical comorbidities as an explanation for increased mortality in the studied groups, the most common medical causes of death in females were included in the PSM model. We were unable to determine the specific cause of death in each case due to limitations in the TriNetX database. However, the fact that PSM was performed suggests that there is something related to IPV that is increasing mortality. Future studies are needed to determine the specific causes of mortality in this population.

The present study highlights the fact that IPV remains a large problem that has resulted in the death of thousands of females. IPV is a chronic issue that often presents to the ED or ophthalmologists several years after it has started. Ocular and orbital trauma resulting from IPV is likely a marker of escalating violence that increases the likelihood of hospitalization and mortality. Ophthalmologists should be aware of the signs of IPV and ensure they are providing patients with the appropriate resources, as these interventions may be lifesaving. In future studies, researchers should incorporate uniform criteria when assessing IPV and incorporate clear outcomes like hospitalization and mortality to ensure that effective strategies for managing IPV are developed.

Funding/Support:

This work was supported by the National Eye Institute K23 Grant, K23EY035741, and E. Matlida Ziegler Foundation for the Blind for Chase A. Ludwig, MD, MS, as well as the National Institute of Health under Grant NIH P30 026877 and Research to Prevent Blindness under an unrestricted grant.

Footnotes

Prior Presentations: This abstract was presented at the ASOPRS 2024 Fall Scientific Symposium.

CREDIT AUTHORSHIP CONTRIBUTION STATEMENT

Linus Amarikwa: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Lynette M. Renner: Writing – review & editing, Validation, Supervision, Methodology, Conceptualization. Natalie A. Homer: Writing – review & editing, Methodology, Conceptualization. Karen M. Wai: Writing – review & editing, Methodology, Conceptualization. Chase A. Ludwig: Writing – review & editing, Methodology, Conceptualization. Euna Koo: Writing – review & editing, Methodology, Conceptualization. Ehsan Rahimy: Writing – review & editing, Methodology, Conceptualization. Prithvi Mruthyunjaya: Writing – review & editing, Supervision, Methodology, Funding acquisition. Erin M. Shriver: Writing – review & editing, Writing – original draft, Supervision, Methodology, Conceptualization. Andrea L. Kossler: Writing – review & editing, Writing – original draft, Supervision, Project administration, Methodology, Investigation, Formal analysis, Conceptualization.

Financial Disclosures: ALK is a consultant for Amgen (consultant, independent contractor), Immunovant (consultant/advisor), Viridian (consultant, independent contractor), Sling Therapeutics (independent contractor), Genentech (consultant), Kriya (consultant), Aceylrin (consultant, independent contractor), Argenx (consultant), Lassen (consultant, independent contractor). EMS is a consultant for Amgen (consultant/advisor) and Genentech (consultant/advisor).

REFERENCES

  • 1.Breiding M, Basile KC, Smith SG, Black MC, Mahendra RR. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements. Version 2.0. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2015. [Google Scholar]
  • 2.Rowh A, Jack S. Notes from the field: intimate partner Homicide among women—United States, 2018–2021. MMWR Morb Mortal Wkly Rep. 2024;73(34):754–756. doi: 10.15585/mmwr.mm7334a4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Leemis RW, Friar N, Khatiwada S, et al. The National intimate partner and sexual violence survey: 2016/2017 Report on intimate partner violence. Centers for disease control and prevention and control; 2022. https://www.cdc.gov/nisvs/documentation/NISVSReportonIPV_2022.pdf. [Google Scholar]
  • 4.Berrios DC, Grady D. Domestic violence. Risk factors and outcomes. West J Med. 1991;155(2):133–135. [PMC free article] [PubMed] [Google Scholar]
  • 5.Wu V, Huff H, Bhandari M. Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma Violence Abuse. 2010;11(2):71–82. doi: 10.1177/1524838010367503. [DOI] [PubMed] [Google Scholar]
  • 6.Alfaro Quezada J, Mustafa Z, Zhang X, et al. A nationwide study of intimate partner violence. Am Surg. 2020;86(10):1230–1237. doi: 10.1177/0003134820964191. [DOI] [PubMed] [Google Scholar]
  • 7.Beck SR, Freitag SK, Singer N. Ocular injuries in battered women. Ophthalmology. 1996;103(1):148–151. doi: 10.1016/S0161-6420(96)30748-3. [DOI] [PubMed] [Google Scholar]
  • 8.Cohen AR, Clark TJE, Renner LM, Carter PC, Shriver EM. Intimate partner violence as a mechanism of traumatic ocular injury in women. Can J Ophthalmol. 2019;54(3):355–358. doi: 10.1016/j.jcjo.2018.05.017. [DOI] [PubMed] [Google Scholar]
  • 9.Hicks PM, Murtaugh MA, DeAngelis MM. The possible impact of increased physical intimate partner violence during the COVID-19 pandemic on ocular health. SAGE Open Med. 2021;9:20503121211035263. doi: 10.1177/20503121211035263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Clark TJ, Renner LM, Sobel RK, et al. Intimate partner violence: an underappreciated etiology of orbital floor fractures. Ophthalmic Plast Reconstr Surg. 2014;30(6):508–511. doi: 10.1097/iop.0000000000000165. [DOI] [PubMed] [Google Scholar]
  • 11.Saenz NM, Tallman SD. Fracture variation in survivable versus fatal blunt force trauma associated with intimate partner violence. Forensic Sci Int. 2024;357:112000. doi: 10.1016/j.forsciint.2024.112000. [DOI] [PubMed] [Google Scholar]
  • 12.Sheridan DJ, Nash KR. Acute injury patterns of intimate partner violence victims. Trauma Violence Abuse. 2007;8(3):281–289. doi: 10.1177/1524838007303504. [DOI] [PubMed] [Google Scholar]
  • 13.Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SP, Lyons BH. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence — United States, 2003–2014. MMWR Morb Mortal Wkly Rep. 2017;66:741–746. doi: 10.15585/mmwr.mm6628a1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Taylor-Butts A Section 1: Overview of Family Violence. In:Family violence in Canada: a statistical profile, 2013. Canadian Centre for Justice Statistics. 2015. [Google Scholar]
  • 15.Rennison CM. Intimate Partner Violence and Age of Victim, 1993–99US. Department of Justice, Office of Justice Programs, Bureau of Justice; 2001. [Google Scholar]
  • 16.Breiding MJ, Chen J, Black MC. Intimate partner violence in the United States—2010. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2014. https://stacks.cdc.gov/view/cdc/21961. [Google Scholar]
  • 17.US Preventive Services Task ForceScreening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation Statement. JAMA. 2018;320(16):1678–1687. doi: 10.1001/jama.2018.14741. [DOI] [PubMed] [Google Scholar]
  • 18.MacMillan HL, Wathen CN, Jamieson E, et al. Screening for intimate partner violence in health care settings: a randomized trial. JAMA. 2009;302(5):493–501. [DOI] [PubMed] [Google Scholar]
  • 19.Feltner C, Wallace I, Berkman N, et al. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;320(16):1688–1701. doi: 10.1001/jama.2018.13212. [DOI] [PubMed] [Google Scholar]
  • 20.Trabold N, McMahon J, Alsobrooks S, Whitney S, Mittal M. A systematic review of intimate partner violence interventions: state of the field and implications for practitioners. Trauma Violence Abuse. 2020;21(2):311–325. doi: 10.1177/1524838018767934. [DOI] [PubMed] [Google Scholar]
  • 21.Rebbe R, Adhia A, Eastman AL, Chen M, Winn J. The measurement of intimate partner violence using International Classification of Diseases diagnostic codes: a systematic review. Trauma Violence Abuse. 2022;24(4):2165–2180. doi: 10.1177/15248380221090977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Stöckl H, Devries K, Rotstein A, et al. The global prevalence of intimate partner homicide: a systematic review. The Lancet. 2013;382(9895):859–865. doi: 10.1016/S0140-6736(13)61030-2. [DOI] [PubMed] [Google Scholar]
  • 23.AbiNader MA, Graham LM, Kafka JM. Examining intimate partner violence-related fatalities: past lessons and future directions using U.S. National data. J Fam Violence. 2023:1–12. doi: 10.1007/s10896-022-00487-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Moracco KE, Cole TB. Preventing intimate partner violence: screening is not enough. JAMA. 2009;302(5):568–570. doi: 10.1001/jama.2009.1135. [DOI] [PubMed] [Google Scholar]
  • 25.Abrahams N, Jewkes R, Martin LJ, Mathews S, Vetten L, Lombard C. Mortality of women from intimate partner violence in South Africa: a national epidemiological study. Violence Vict. 2009;24(4):546–556. doi: 10.1891/0886-6708.24.4.546. [DOI] [PubMed] [Google Scholar]
  • 26.Teichman AL, Bonne S, Rattan R, et al. Screening and intervention for intimate partner violence at trauma centers and emergency departments: an evidence-based systematic review from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open. 2023;8(1):e001041. doi: 10.1136/tsaco-2022-001041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Cohen AR, Renner LM, Shriver EM. Intimate partner violence in ophthalmology: a global call to action. Curr Opin Ophthalmol. 2017;28(5):534–538. doi: 10.1097/icu.0000000000000397. [DOI] [PubMed] [Google Scholar]
  • 28.Shum M, Robertson D, Ryus C, Tiyyagura G. The role of International Classification of Diseases 10 codes in intimate partner violence surveillance: examining the sensitivity and specificity of current practice. Ann Emerg Med. 2024;84(2):220–222. doi: 10.1016/j.annemergmed.2024.03.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Akinyemi O, Ogundare T, Oladunjoye AF, et al. Factors associated with suicide/self-inflicted injuries among women aged 18–65 years in the United States: a 13-year retrospective analysis of the National Inpatient Sample database. PLoS One. 2023;18(10):e0287141. doi: 10.1371/journal.pone.0287141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Lundberg J, Cars T, Lampa E, et al. Determinants and outcomes of suicidal behavior among patients with major depressive disorder. JAMA Psychiatry. 2023;80(12):1218–1225. doi: 10.1001/jamapsychiatry.2023.2833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Hser YI, Kagihara J, Huang D, Evans E, Messina N. Mortality among substance-using mothers in California: a 10-year prospective study. Addiction. 2012;107(1):215–222. doi: 10.1111/j.1360-0443.2011.03613.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Kinner SA, Degenhardt L, Coffey C, et al. Substance use and risk of death in young offenders: a prospective data linkage study. Drug Alcohol Rev. 2015;34(1):46–50. doi: 10.1111/dar.12179. [DOI] [PubMed] [Google Scholar]
  • 33.Centers for Disease Control and Prevention. QuickStatsAge-adjusted death rates for females aged 15–44 years, by the five leading causes of death—United States, 1999 and 2014. MMWR Morb Mortal Wkly Rep. 2016;65:659. doi: 10.15585/mmwr.mm6525a6. [DOI] [PubMed] [Google Scholar]
  • 34.Alik M, Malik M, Ashrafi R, Wu AY. Epidemiologic pattern and injury mechanism of intimate partner violence—related ocular trauma in the US. JAMA Ophthalmol. 2023;141(5):431–439. doi: 10.1001/jamaophthalmol.2023.0578. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Dawoud SA, Cohen AR, Renner LM, Clark TJ, Zimmerman MB, Shriver EM. Detection and referral of orbital and ocular injuries associated with intimate partner violence following an educational and screening initiative in an emergency department. JAMA Ophthalmol. 2021;139(7):785–789. doi: 10.1001/jamaophthalmol.2021.1546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Andoh JE, Mehta SK, Chen EM, Mir TA, Nwanyanwu K, Teng CC. Domestic violence-related ocular injuries among adult patients: data from the Nationwide Emergency Department Sample, 2008–2017. Ophthalmic Epidemiol. 2024;31(2):169–177. doi: 10.1080/09286586.2023.2222792. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Khurana B, Loder RT. Injury patterns and associated demographics of intimate partner violence in older adults presenting to U.S. emergency departments. J Interpers Violence. 2022;37(17–18):NP16107–NP16129. doi: 10.1177/08862605211022060. [DOI] [PubMed] [Google Scholar]
  • 38.Saddki N, Suhaimi AA, Daud R. Maxillofacial injuries associated with intimate partner violence in women. BMC Public Health. 2010;10(1):268. doi: 10.1186/1471-2458-10-268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Le BT, Dierks EJ, Ueeck BA, Homer LD, Potter BF. Maxillofacial injuries associated with domestic violence. J Oral Maxillofac Surg. 2001;59(11):1277–1283. doi: 10.1053/joms.2001.27490. [DOI] [PubMed] [Google Scholar]
  • 40.Gujrathi R, Tang A, Thomas R, et al. Facial injury patterns in victims of intimate partner violence. Emerg Radiol. 2022;29(4):697–707. doi: 10.1007/s10140-022-02052-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Porter A, Montgomery CO, Montgomery BE, Eastin C, Boyette J, Snead G. Intimate partner violence-related fractures in the United States: an 8 year review. J Fam Violence. 2019;34(7):601–609. doi: 10.1007/s10896-018-0007-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Goldberg SH, McRill CM, Bruno CR, Ten Have T, Lehman E. Orbital fractures due to domestic violence: an epidemiologic study. Orbit. 2000;19(3):143–154. doi: 10.1076/orbi.19.3.143.2659. [DOI] [PubMed] [Google Scholar]
  • 43.Perciaccante VJ, Ochs HA, Dodson TB. Head, neck, and facial injuries as markers of domestic violence in women. J Oral Maxillofac Surg. 1999;57(7):760–762. doi: 10.1016/S0278-2391(99)90808-X. [DOI] [PubMed] [Google Scholar]
  • 44.Halpern LR. Orofacial injuries as markers for intimate partner violence. Oral Maxillofac Surg Clin. 2010;22(2):239–246. doi: 10.1016/j.coms.2010.01.009. [DOI] [PubMed] [Google Scholar]
  • 45.Arosarena OA, Fritsch TA, Hsueh Y, Aynehchi B, Haug R. Maxillofacial injuries and violence against women. Arch Facial Plast Surg. 2009;11(1):48–52. doi: 10.1001/archfaci.2008.507. [DOI] [PubMed] [Google Scholar]
  • 46.Walker LE. Battered woman syndrome. Ann NY Acad Sci. 2006;1087(1):142–157. doi: 10.1196/annals.1385.023. [DOI] [PubMed] [Google Scholar]
  • 47.FitzPatrick KM, Brown S, Hegarty K, Mensah F, Gartland D. Visualising patterns in women’s experiences of intimate partner violence in the first 10 years of motherhood. J Interpers Violence. 2023;38(3–4):3055–3087. doi: 10.1177/08862605221104518. [DOI] [PubMed] [Google Scholar]
  • 48.Cochran JK, Sellers CS, Wiesbrock V, Palacios WR. Repetitive intimate partner victimization: an exploratory application of social learning theory. Deviant Behav. 2011;32(9):790–817. doi: 10.1080/01639625.2010.538342. [DOI] [Google Scholar]
  • 49.Triantafyllou D, Wang C, North CS. Correlates of duration of intimate partner violence among women seeking services at a domestic violence support center. J Interpers Violence. 2019;34(6):1127–1138. doi: 10.1177/0886260516647522. [DOI] [PubMed] [Google Scholar]
  • 50.Kafka JM, Moracco KE, Taheri C, et al. Intimate partner violence victimization and perpetration as precursors to suicide. SSM—Popul Health. 2022;18:101079. doi: 10.1016/j.ssmph.2022.101079. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.McManus S, Walby S, Barbosa EC, et al. Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England. Lancet Psychiatry. 2022;9(7):574–583. doi: 10.1016/S2215-0366(22)00151-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Sprague S, Madden K, Simunovic N, et al. Barriers to screening for intimate partner violence. Women & Health. 2012;52(6):587–605. doi: 10.1080/03630242.2012.690840. [DOI] [PubMed] [Google Scholar]
  • 53.Mehr JB, Bennett ER, Price JL, et al. Intimate partner violence, substance use, and health comorbidities among women: a narrative review. Front Psychol. 2023;13. doi: 10.3389/fpsyg.2022.1028375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Kraanen FL, Vedel E, Scholing A, Emmelkamp PMG. Prediction of intimate partner violence by type of substance use disorder. J Subst Abuse Treat. 2014;46(4):532–539. doi: 10.1016/j.jsat.2013.10.010. [DOI] [PubMed] [Google Scholar]
  • 55.Smith PH, Homish GG, Leonard KE, Cornelius JR. Intimate partner violence and specific substance use disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Addict Behav. 2012;26(2):236–245. doi: 10.1037/a0024855. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Chermack ST, Murray RL, Walton MA, Booth BA, Wryobeck J, Blow FC. Partner aggression among men and women in substance use disorder treatment: correlates of psychological and physical aggression and injury. Drug Alcohol Depend. 2008;98(1):35–44. doi: 10.1016/j.drugalcdep.2008.04.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Violence Policy Center. When men murder women: an analysis of 2020 homicide data; 2022. https://www.vpc.org/studies/wmmw2022.pdf.
  • 58.Kelly LC, Spencer CM, Keilholtz B, McAllister P, Stith SM. Is separate the new equal? A meta-analytic review of correlates of intimate partner violence victimization for black and white women in the United States. Fam Process. 2022;61(4):1473–1488. doi: 10.1111/famp.12754. [DOI] [PubMed] [Google Scholar]
  • 59.Holliday CN, Kahn G, Thorpe RJ Jr, Shah R, Hameeduddin Z, Decker MR. Racial/ethnic disparities in police reporting for partner violence in the National Crime Victimization Survey and survivor-led interpretation. J Racial Ethn Health Disparities. 2020;7(3):468–480. doi: 10.1007/s40615-019-00675-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Waller BY, Harris J, Quinn CR. Caught in the cross-road: an intersectional examination of African American women intimate partner violence survivors’ help seeking. Trauma Violence Abuse. 2022;23(4):1235–1248. doi: 10.1177/1524838021991303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Nelson T, Shahid NN, Cardemil EV. Do I really need to go and see somebody? Black women’s perceptions of help-seeking for depression. J Black Psychol. 2020;46(4):263–286. doi: 10.1177/0095798420931644. [DOI] [Google Scholar]
  • 62.Wadsworth T, Roberts JM Jr. When missing data are not missing: a new approach to evaluating supplemental homicide report imputation strategies. Criminology. 2008;46(4):841–870. doi: 10.1111/j.1745-9125.2008.00129.x. [DOI] [Google Scholar]
  • 63.Wilson RF, Blair JM. Racial inequities in homicide rates: black women in the USA. The Lancet. 2024;403(10430):882–883. doi: 10.1016/S0140-6736(23)02585-0. [DOI] [PubMed] [Google Scholar]
  • 64.Campbell JC, O’Sullivan C, Roehl J, Webster D. Intimate Partner Violence Risk Assessment Validation Study, Final Report. National Institute of Justice; 2005. [Google Scholar]
  • 65.Langford L, Isaac N, Kabat S. Homicides related to intimate partner violence in Massachusetts: examining case ascertainment and validity of the SHR. Homicide Stud. 1998;2(4):353–377. doi: 10.1177/1088767998002004002. [DOI] [Google Scholar]
  • 66.Sbarra DA, Law RW, Portley RM. Divorce and death: a meta-analysis and research agenda for clinical, social, and health psychology. Perspect Psychol Sci. 2011;6(5):454–474. doi: 10.1177/1745691611414724. [DOI] [PubMed] [Google Scholar]
  • 67.Dim EE, Elabor-Idemudia P. Severity and predictors of physical intimate partner violence against male victims in Canada. J Aggress Maltreatment Trauma. 2024;33(1):85–108. doi: 10.1080/10926771.2020.1853298. [DOI] [Google Scholar]
  • 68.Ellis D Marital separation and lethal male partner violence. Violence Against Women. 2017;23(4):503–519. doi: 10.1177/1077801216644985. [DOI] [PubMed] [Google Scholar]
  • 69.Aldridge ML, Browne KD. Perpetrators of spousal homicide: a review. Trauma Violence Abuse. 2003;4(3):265–276. doi: 10.1177/1524838003004003005. [DOI] [PubMed] [Google Scholar]
  • 70.Gillespie CK Justifiable Homicide: Battered Women, Self-Defense, and the Law. Ohio State University Press, Columbus; 1989:49. [Google Scholar]
  • 71.Schafer SD, Drach LL, Hedberg K, Kohn MA. Using diagnostic codes to screen for intimate partner violence in Oregon emergency departments and hospitals. Public Health Rep (1974-). 2008;123(5):628–635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Rebbe R, Adhia A, Eastman AL, Chen M, Winn J. The measurement of intimate partner violence using International Classification of Diseases diagnostic codes: a systematic review. Trauma Violence Abuse. 2023;24(4):2165–2180. doi: 10.1177/15248380221090977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73.Campbell JC, Glass N, Sharps PW, Laughon K, Bloom T. Intimate partner homicide: review and implications of research and policy. Trauma Violence Abuse. 2007;8(3):246–269. doi: 10.1177/1524838007303505. [DOI] [PubMed] [Google Scholar]
  • 74.Syed S, Ashwick R, Schlosser M, Gonzalez-Izquierdo A, Li L, Gilbert R. Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis. Arch Dis Child. 2021;106(1):44–53. doi: 10.1136/archdischild-2020-319027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75.Gosangi B, Park H, Thomas R, et al. Exacerbation of physical intimate partner violence during COVID-19 pandemic. Radiology. 2021;298(1):E38–E45. doi: 10.1148/radiol.2020202866. [DOI] [PMC free article] [PubMed] [Google Scholar]

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