Racial Disparities in Cleft Lip Repair: A National Assessment

Abstract

Background/purposeRacial disparities in surgical care in the United States have been previously demonstrated. In cleft lip repair, however, an association between race and outcomes has not been established. This study aimed to identify the impact of race on timing, costs, and complications following cleft lip repair using the Kids’ Inpatient Database (KID). MethodsPatients who underwent cleft lip repair were identified in the KID database from 2006 to 2012. Demographic data collected included race, diagnosis, insurance status, the mean income of patient Zip Code (as proxy for socioeconomic status), hospital costs, and comorbidities. ANOVA and Chi-squared analyses were used to assess differences in demographic variables across races. Bivariable linear and logistic regression models were used to identify gross differences in timing of surgery, cost of surgery, and hospital length of stay (LOS) for each race in comparison to white patients. Multivariable models were performed across the same parameters to adjust for other contributing variables. ResultsIn total, 5927 patients were identified with cleft lip: 3724 white, 279 black, 1316 Hispanic, 277 Asian/Pacific-Islander, and 331 other races. Cleft diagnoses differed by race (P < .001); bilateral clefts were most frequent among Hispanic patients (29.7%), and white patients were most likely to have concurrent diagnosis of cleft palate (70.4%). There were significant differences in insurance and income status by race (P < .001), with black patients most likely to utilize Medicaid (69.8%) and live in lowest-income quartile areas (45.9%). Overall, white patients received cleft lip repair earlier (3.8 months) than all other patients (P < .001). Hospital charges were also lower among white patients than all other groups (P < .001), with non-white patients costing an additional $10,910.25 per stay. Race-based differences in both timing and costs persisted (P < .05), even when controlling for other factors, with greatest delays (+4.0 months) and highest costs (+$5385.67) among Asian patients. Significant differences (P < .001) were also seen in LOS for each race when compared to whites (1.34 days) with highest LOS seen in black patients (1.99 days). However, race-based differences in LOS were not significant in multivariable regression, which showed a mediating effect by low-income status (P = .017) and comorbidities (P < .001). Similarly, while a minimal increase in complications was seen among Asian patients (OR 1.01, P = .001), these differences were largely mediated by the severity of patient comorbidities (P < .001). ConclusionRace was associated with significant differences in admission characteristics and outcomes in cleft lip repair. White patients generally underwent surgical repair earlier, incurred fewer hospital charges, and experienced shorter lengths of stay and fewer complications than their non-white counterparts. Disparities appear to be partially mediated by differences in socioeconomic status and underlying patient health, among other factors. Future efforts should aim to identify barriers to cleft care and minimize disparities for minority patients.