To investigate the structural and intermediary determinants of health-related quality of life (HRQoL) and oral health–related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P).
Design and Participants:
A cross-sectional study was conducted with patients enrolled at the referral center for craniofacial anomalies in Manaus, Brazil. Adults aged 18 years or more with nonsyndromic CL/P were selected.
Main Outcome Measures:
Both HRQoL and OHRQoL were assessed using the 36-item Short-Form Health Survey and the Oral Impacts on Daily Performance, respectively. Individual interviews and oral examinations were conducted to collect data on socioeconomic and demographic characteristics, social ties, health-related behaviors, compliance of CL/P protocol, chronic diseases, type of CL/P, oral clinical measures, and CL/P-related measures. Poisson regression was used to test the association of independent variables with HRQoL and OHRQoL outcomes.
Results:
The mean age of the 96 participants was 29.4 ± 9.1 years. Low family income, female sex, low social support, type of CL/P, and dental caries were associated with poor HRQoL and poor OHRQoL (P < .05). Poor HRQoL was also associated with chronic diseases (P < .05). Adults with low education, low social network, and smokers were more likely to have worse OHRQoL (P < .05).
Conclusions:
Structural and intermediary determinants were related to HRQoL and OHRQoL in adults with CL/P, suggesting the need for interdisciplinary approaches to improve the management of CL/P and intersectoral actions to reduce the impact of social inequalities.
AcreeLSLongforsJFjeldstadASFjeldstadCSchankBNickelKJMontgomeryPSGardnerAW. Physical activity is related to quality of life in older adults. Health Qual Life Outcomes. 2006;30;4:37.
2.
AdulyanonSVourapukjaruJSheihamA. Oral impacts affecting daily performance in a low dental disease Thai population. Community Dent Oral Epidemiol. 1996;24(6):385–389.
3.
Al-NaggarRANagiNMAliMMAlmuasliM. Quality of life among breast cancer patients in Yemen. Asian Pac J Cancer Prev. 2011;12(9):2335–2341.
4.
AndradeGRVaitsmanJ. Social support and network: connecting solidarity and health. Cienc Saude Coletiva. 2002;7:925–934.
5.
AntonarakisGSPalaskaPKHerzogG. Caries prevalence in non-syndromic patients with cleft lip and/or palate: a meta-analysis. Caries Res. 2013;47(5):406–413.
6.
Asher-McDadeCRobertsCShawWCGallagerC. Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J. 1991;28(4):385–390.
7.
BerkmanLFSymeSL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109(2):186–204.
8.
BircherJKuruvillaS. Defining health by addressing individual, social, and environmental determinants: new opportunities for health care and public health. J Public Health Policy. 2014;35(3):363–386.
9.
Brazil, Ministry of Health. SB Brazil 2010 Project: National Oral Health Survey—Main Results. Brasília: Ministry of Health; 2012.
10.
BrattströmVMølstedKPrahl-AndersenBSembGShawWC. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2: craniofacial form and nasolabial appearance. Cleft Palate Craniofac J. 2005;42(1):69–77.
11.
BrennanDSSpencerAJ. Social support and optimism in relation to the oral health of young adults. Int J Behav Med. 2012;19(1):56–64.
12.
BroderHLWilson-GendersonMSischoL. Health disparities among child with cleft. Am J Public Health. 2012;102(5):828–830.
13.
BroderHLWilson-GendersonMSischoL. Examination of a theoretical model for oral health-related quality of life among youths with cleft. Am J Public Health. 2014a;104(5):865–871.
14.
BroderHLWilson-GendersonMSischoLNormanRG. Examining factors associated with oral health-related quality of life for youth with cleft. Plast Reconstr Surg. 2014b;133(6):828e–834e.
15.
ChorDGriepRHLopesCSFaersteinE. Medidas de rede e apoio social no Estudo Pró-Saúde: pré-testes e estudo piloto. Cad Saude Publica. 2001;17(4):887–896.
16.
CiconelliRMFerrazMBSantosWMeinãoIQuaresmaMR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol. 1999;39:143–150.
17.
ColletBRCloonanYKSpeltzMLAnderkaMWerlerMM. Psychosocial functioning in children with and without orofacial clefts and their parents. Cleft Palate Craniofac J. 2012;49(4):397–405.
18.
CortesMIMarcenesWSheihamA. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children. Community Dent Oral Epidemiol. 2002;30(3):193–198.
19.
DamianoPCTylerMCRomittiPAMomanyETJonesMPCanadyJWKarnellMPMurrayJC. Health-related quality of life among preadolescent children with oral clefts: the mother’s perspectives. Pediatrics. 2007;120(2):283–90.
20.
Dak-AlbabRJDashashMA. The influence of socioeconomic status on oral health-related quality of life among Syrian children with cleft lip, or palate, or both. Saudi Med J. 2013;34(2):181–186.
21.
DoLGSpencerAJ. Evaluation of oral health-related quality of life questionnaires in a general child population. Community Dent Health. 2008;25(4):205–210.
22.
EndrigaMCKapp-SimonKA. Psychological issues in craniofacial care: state of the art. Cleft Palate Craniofac J. 1999;36(1):3–11.
23.
FleckMPLouzadaSXavierMChachamovichEVieiraGSantosLPinzonV. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100). Rev Saude Publica. 1999;33(2):198–205.
24.
FooPSampsonWJRobertsRMJamiesonLMDavidDJ. General health-related quality of life and oral health impact among Australians with cleft compared with population norms; age and gender differences. Cleft Palate Craniofac J. 2012;49(4):406–413.
25.
FreitasJAGaribDGOliveiraMLauris RdeCAlmeidaALNevesLTTrindade-SuedamIKYaedúRYSoaresSPintoJH. Rehabilitative treatment of cleft lip and palate: experience of the hospital for rehabilitation of craniofacial anomalies/USP (HRAC/USP)—part 1: overall aspects. J Appl Oral Sci. 2012;20(1):9–15.
26.
Garcia-SubiratsIVargasIMogollón-PérezASDe PaepePda SilvaMRUngerJPBorrellCVázquezML. Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. Int J Equity Health. 2014;13:10.
27.
GomesMCPinto-SarmentoTCCostaEMMartinsCCGranville-GarciaAFPaivaSM. Impact of oral health conditions on the quality of life of preschool children and their families: a cross-sectional study. Health Qual Life Outcomes. 2014;12:55.
28.
HuntOBurdenDHepperPJohnstonC. The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthod. 2005;27(3):274–285.
29.
KramerFJGruberRFialkaFSinikovicBHahnWSchliephakeH. Quality of life in school-age children with orofacial clefts and their families. J Craniofac Surg. 2009;20(6):2061–2066.
30.
Kuijpers-JagtmanAMNolletPJSembGBronkhorstEMShawWCKatsarosC. Reference photographs for nasolabial appearance rating in unilateral cleft lip and palate. J Craniofac Surg. 2009;20(suppl 2):1683–1686.
31.
KumarSKroonJLallooR. A systematic review of the impact of parental socio-economic status and home environment characteristics on children’s oral health related quality of life. Health Qual Life Outcomes. 2014;12:41.
32.
LockerDAllenF. What do measures of ‘oral health-related quality of life’ measure?Community Dent Oral Epidemiol. 2007;35(6):401–411.
33.
LuaPLHaronHCosmasGNawiNH. The impact of demographic characteristics on health-related quality of life profile of Malaysian epilepsy population. Appl Res Qual Life. 2007;2:247–271.
34.
ManiMCarlssonMMarcussonA. Quality of life varies with gender and age among adults treated for unilateral cleft lip and palate. Cleft Palate Craniofac J. 2010;47(5):491–498.
35.
MarcussonAAkerlindIPaulinG. Quality of life in adults with repaired complete cleft lip and palate. Cleft Palate Craniofac J. 2001;38(4):379–385.
36.
MasurJMonteiroMG. Validation of the “CAGE” alcoholism screening test in a Brazilian psychiatric inpatient hospital setting. Braz J Med Biol Res. 1983;16(3):215–218.
37.
MercadoARussellKHathawayRDaskalogiannakisJSadekHLongREJrCohenMSembGShawW. The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 4. Nasolabial aesthetics. Cleft Palate Craniofac J. 2011;48(3):259–264.
38.
MichelsonHBoilundCBrandbergY. Multiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of age. Quality Life Res. 2001;9(10):1093–1104.
39.
MitraMChungMCWilberNKlein WalkerD. Smoking status and quality of life: a longitudinal study among adults with disabilities. Am J Prev Med. 2004;27(3):258–260.
40.
MohebbiSZSheikhzadehSBatebiABassirSH. Oral impacts on daily performance in 20- to 50-year-olds demanding dental care in Tehran, Iran: association with clinical findings and self-reported health. Oral Health Prev Dent. 2014;12(1):29–36.
41.
MølstedKBrattströmVPrahl-AndersenBShawWCSembG. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 3: dental arch relationships. Cleft Palate Craniofac J. 2005;42(1):78–82.
42.
MunzSMEdwardsSPInglehartMR. Oral health-related quality of life, and satisfaction with treatment and treatment outcomes of adolescents/young adults with cleft lip and palate: an exploration. Int J Oral Maxillofac Surg. 2011;40(8):790–796.
43.
MurrayLArtecheABingleyCHentgesFBishopDVDaltonLGoodacreTHillJ; Cleft Lip and Palate Study Team. The effect of cleft lip on socio-emotional functioning in school-aged children. J Child Psychol Psychiatry. 2010;51(1):94–103.
44.
NettletonS. The Sociology of Health and Illness. Cambridge, United Kingdom: Polity Press, 1995.
45.
OosterkampBCDijkstraPURemmelinkHJvan OortRPGoorhuis-BrouwerSMSandhamAde BontLG. Satisfaction with treatment outcome in bilateral cleft lip and palate patients. Int J Oral Maxillofac Surg. 2007;36(10):890–895.
46.
Queiroz HerkrathAPHerkrathFJRebeloMAVettoreMV. Measurement of health-related and oral health–related quality of life among individuals with nonsyndromic orofacial clefts: a systematic review and meta-analysis. Cleft Palate Craniofac J. 2015;52(2):157–172.
47.
RamstadTOttemEShawWC. Psychosocial adjustment in Norwegian adults who had undergone standardised treatment of complete cleft lip and palate. I. Education, employment and marriage. Scand J Plast Reconstr Surg Hand Surg. 1995;29(3):251–257.
48.
ReddySGReddyRRBronkhorstEMPrasadRKuijpers JagtmanAMBergéS. Health related quality of life of patients with non-syndromic orofacial clefts. J Oral Maxillofac Surg. 2012;24:6–10.
49.
RoncalliAGda SilvaNNNascimentoACFreitasCHSMCasottiEPeresKGde MouraLPeresMAFreireMdCMde Souza CortesMI. Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde. Cad Saude Publica. 2012;28:s40–s57.
50.
RumseyNHarcourtD. Body image and disfigurement: issues and interventions. Body Image. 2004;1(1):83–97.
51.
SankJRBerkNWCooperMEMarazitaML. Perceived social support of mothers of children with clefts. Cleft Palate Craniofac J. 2003;40(2):165–171.
52.
SherbourneCDStewartAL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–714.
53.
SinkoKJagschRPrechtlVWatzingerFHollmannKBaumannA. Evaluation of esthetic, functional, and quality-of-life outcome in adult cleft lip and palate patients. Cleft Palate Craniofac J. 2005;42(4):355–361.
54.
ThompsonAKentG. Adjusting to disfigurement: processes involved in dealing with being visibly different. Clin Psychol Rev. 2001;21(5):663–682.
55.
TrentiniCMChachamovichEWagnerGPMullerDHHirakataVNFleckMP. Quality of life (QoL) in a Brazilian sample of older adults: the role of sociodemographic variables and depression symptoms. Appl Res Qual Life. 2011;6:291–309.
56.
TurnerSRRumseyNSandyJR. Psychological aspects of cleft lip and palate. Eur J Orthod. 1998;20(4):407–415.
57.
TurnerSRThomasPWNDowellTRumseyNSandyJR. Psychological outcomes amongst cleft patients and their families. Br J Plast Surg. 1997;50(1):1–9.
58.
VadstrupESFrølichAPerrildHBorgERøderM. Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling. Health Qual Life Outcomes. 2011;9:110.
59.
WareJESherbourneCD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.
60.
World Health Organization. Noncommunicable Diseases Country Profiles2011. Geneva, Switzerland: World Health Organization; 2011.
61.
World Health Organization. Oral Health Surveys: Basic Methods. 4 ed. Geneva, Switzerland: World Health Organization; 1997.
62.
World Health Organization Quality of Life Group. Measuring Quality of Life: The World Health Organization Quality of Life Instruments (The WHO-QOL-100 and the WHOQOL-BREF). Geneva, Switzerland: World Health Organization; 1997.
63.
World Health Organization. A Conceptual Framework for Action on the Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2010.
64.
YusofZYJaafarN. Health promoting schools and children’s oral health related quality of life. Health Qual Life Outcomes. 2013;11:205.
