Risk Factors Associated With Bell's Palsy: A Real‐World Analysis of 281,600 Patients

Introduction Bell's palsy is the most common cause of peripheral facial paralysis, with an annual incidence of 5–50 per 100,000 cases worldwide. Its etiology remains largely unknown, though risk factors such as herpes simplex virus reactivation, diabetes, depression, and pregnancy‐related complications have been suggested. Understanding these risk factors is critical for improving diagnosis, prevention, and treatment strategies. Methods A retrospective analysis of the TriNetX database included over 25 million patients. Two cohorts of approximately 140,800 patients each, matched for age and sex, were analyzed for associations between BP and herpes simplex virus, diabetes, depression, and pregnancy. Odds ratios (OR) and confidence intervals (CI) were calculated, with p < 0.05 indicating significance. Results Herpes simplex virus showed the strongest association with Bell's palsy (OR: 6.49, 95% CI: 5.96–7.05); followed by diabetes (OR: 2.4, CI: 2.36–2.46) and depression (OR: 2.05, CI: 2.0–2.1). Pregnancy was inversely correlated (OR: 0.76, CI: 0.73–0.78). Conclusion Herpes simplex virus reactivation appears to be a major risk factor, suggesting a potential role of antiviral therapies in select cases. The associations with diabetes and depression highlight a need for metabolic and mental health evaluations in patients with Bell's palsy. The inverse correlation with pregnancy warrants further investigation into pregnancy‐related conditions. These findings emphasize the multifactorial nature of this condition and the importance of individualized approaches to reduce its idiopathic classification.