Race, Income, and the Timeliness of Cleft Palate Repair in the United States.

Jennifer L Harb,Andrew R Scott,Cullen Roberts,Kayva L Crawford,Jonathan C Simmonds

doi:10.7759/cureus.13414

Abstract

ObjectiveTo determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States.DesignRetrospective cross-sectional study using the Kids’ Inpatient Database (KID) from 1997 to 2009.SettingInpatient.PatientsChildren with cleft palate with or without cleft lip undergoing inpatient cleft palate repair.Main outcome measuresAge at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location.ResultsA total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months (95% CI 12.0-12.3). Females underwent palatoplasty at an older age (13.6 months) than males (13.2 months), a difference of 0.47 months (SE: 0.19, p=0.015). White children underwent surgery at an earlier age (12.1 months) than Black (12.9 months) (difference: 0.73 months, SE: 0.37, p=0.045), Hispanic (12.7 months) (difference: 0.57 months, SE 0.25, p=0.025), and Asian children (15.7 months) (difference: 3.60 months, SE 0.49, p<0.0001). Asian children were also found to undergo repair later than Hispanic (difference 3.03 months, SE 0.51, p<0.0001) and Black (difference: 2.87 months, SE 0.59, p<0.0001) children. Patients born into the highest income brackets were repaired 0.75 months earlier than those in the lowest bracket (SE: 0.26, p=0.005). Patients in the Midwest underwent palatoplasty later (14.3 months) than in the Northeast (12.9 months) (difference: 1.36 months, SE: 0.31, p<0.0001), South (13.2 months) (difference: 1.05 months, SE: 0.36, p=0.004), and West (13.2 months) (difference: 1.09 months, SE: 0.32, p=0.0007).ConclusionsAfter controlling for confounding factors, our results suggest that in recent history, Black, Hispanic, and Asian children with cleft palate were repaired later than their White counterparts. In addition, children of affluent families were repaired earliest, and economically disadvantaged children were repaired later than their peers.

Highlights

Orofacial clefting, including cleft lip and cleft palate, is the second most common birth defect in the United States after Down Syndrome [1]
A total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months
After controlling for confounding factors, our results suggest that in recent history, Black, Hispanic, and Asian children with cleft palate were repaired later than their White counterparts

Summary

Introduction

Orofacial clefting, including cleft lip and cleft palate, is the second most common birth defect in the United States after Down Syndrome [1]. In the United States, cleft palate without cleft lip is estimated to occur at a rate of 1:1600 live births [2]. Palatoplasty, or repair of the cleft palate, is a critical procedure for these patients in order to facilitate proper feeding and speech development. The optimal timing of repair has long been debated, as early surgery promotes improved speech outcomes but risks maxillofacial growth. How to cite this article Harb J L, Crawford K L, Simmonds J C, et al (February 18, 2021) Race, Income, and the Timeliness of Cleft Palate Repair in the United States.

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