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

Abstract

Objective To determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States. Design Retrospective cross-sectional study using the Kids’ Inpatient Database (KID) from 1997 to 2009. Setting Inpatient. Patients Children with cleft palate with or without cleft lip undergoing inpatient cleft palate repair. Main outcome measures Age at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location. Results A 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). Conclusions 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. In addition, children of affluent families were repaired earliest, and economically disadvantaged children were repaired later than their peers.

Hospital length of stay among children with and without congenital anomalies across 11 European regions—A population-based data linkage study

“…We have shown that children with congenital anomalies in general and those with specific anomalies have far longer hospital stays than children without congenital anomalies and this cannot only be explained by the surgeries needed for their congenital anomaly. For most of the specific congenital anomalies included in this study surgery takes place within the first year after birth, although for children with a cleft palate or hypospadias corrective surgery may take place later [23][24][25][26]. Despite that, children with congenital anomalies are also more often hospitalised at ages 1-4 years and median LOS is longer compared to reference children.…”

European study showed that children with congenital anomalies often underwent multiple surgical procedures at different ages across Europe

“…We do not know why these differences occurred. Early surgery for a cleft palate may have a negative impact on the growth of the maxilla and late surgery may have a negative impact on speech development 18,19 . The recommended age for surgery for hypospadias is 6–18 months or later in childhood 19‐21 .…”

“…Early surgery for a cleft palate may have a negative impact on the growth of the maxilla and late surgery may have a negative impact on speech development. 18,19 The recommended age for surgery for hypospadias is 6-18 months or later in childhood. [19][20][21] Small anatomy may be a surgical challenge, but one study reported that adolescents who are not able to recall the surgery seemed to have a more positive body image.…”

“…18,19 The recommended age for surgery for hypospadias is 6-18 months or later in childhood. [19][20][21] Small anatomy may be a surgical challenge, but one study reported that adolescents who are not able to recall the surgery seemed to have a more positive body image. 20 This study found that the median age at the time of their first surgical procedure ranged from 61 weeks (14 months) to 131 weeks (30 months) and the centile was 12 months in all the registries.…”

Incidence of cleft lip and palate, and epidemiology of perinatal deaths related to cleft lip and palate in Hunan Province, China, 2016-2020

“…Most cases of postpartum death were associated with severe syndromes, which were not explored in depth in this study, which is a weakness of this study. After prenatal diagnosis, the severity of CL/P and family economic conditions are also important factors affecting abortion (35)(36)(37)(38).…”