To examine whether neighborhood disadvantage impacts length of follow-up, interventions, and outcomes for patients with cleft palate.
Design
Retrospective cohort.
Setting
Cleft Palate Craniofacial Institute Database at St. Louis Children's Hospital.
Patients/Participants
Patients with cleft palate following in St. Louis Children's Hospital Cleft Palate Multidisciplinary Team Clinic.
Interventions
Primary palatoplasty between 2012–2017. Patients were divided into quartiles across area deprivation index (ADI) and social vulnerability index (SVI), two validated, composite metrics of neighborhood disadvantage, to examine whether living in neighborhoods from different deprivation quartiles impacts outcomes of interest.
Main Outcome Measure
Follow-up through age 5, surgeries and surgical complications, speech, developmental, and behavioral outcomes
Results
205 patients were included. 39% of patients belonged to the most deprived ADI quartile, while 15% belonged to the most vulnerable SVI quartile. There were no differences between ADI or SVI quartiles in number of operations received (p ≥ 0.40). Patients in the most deprived ADI quartile were significantly more likely to have speech/language concerns (OR 2.32, 95% CI [1.20–4.89], p = 0.01). Being in a more vulnerable SVI quartile was associated with developmental delay (OR 2.29, 95% CI [1.04–5.15], p = 0.04). ADI and SVI quartile did not impact risk of loss to follow-up in the isolated and combined cleft lip and palate subgroups (p ≥ 0.21).
Conclusions
Neighborhood disadvantage impacts speech and developmental outcomes in patients with cleft palate despite comparable length of follow-up in multidisciplinary team clinic.
GroupIW. Prevalence at birth of cleft lip with or without cleft palate: Data from the international perinatal database of typical oral clefts (IPDTOC). Cleft Palate Craniofac J. 2011;48(1):66-81. doi:https://doi.org/10.1597/09-217
3.
KauraASSrinivasaDRKastenSJ. Optimal timing of alveolar cleft bone grafting for maxillary clefts in the cleft palate population. J Craniofac Surg. 2018;29(6):1551-1557. doi:https://doi.org/10.1097/SCS.0000000000004680
TowneSDJr. Socioeconomic, geospatial, and geopolitical disparities in access to health care in the US 2011-2015. Int J Environ Res Public Health. 2017;14(6):573. doi:https://doi.org/10.3390/ijerph14060573
6.
GoodwinAJNadigNRMcElligottJTSimpsonKNFordDW. Where you live matters: The impact of place of residence on severe sepsis incidence and mortality. Chest. 2016;150(4):829-836. doi:https://doi.org/10.1016/j.chest.2016.07.004
7.
JanevicMRBaptistAPBryant-StephensT, et al.Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence. J Asthma. 2017;54(5):514-519. doi:https://doi.org/10.1080/02770903.2016.1242136
8.
SmillieIYongKHarrisKWynneDMRussellCJ. Socioeconomic influence on orofacial cleft patient care. Scott Med J. 2015;60(2):70-74. doi:https://doi.org/10.1177/0036933014564133
9.
Acuna-GonzalezGMedina-SolisCEMaupomeG, et al.Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: A matched case-control study in a less developed country. Biomedica. 2011;31(3):381-391. doi:https://doi.org/10.1590/S0120-41572011000300010
10.
VuGHWardenCZimmermanCE, et al.Poverty and risk of cleft lip and palate: An analysis of United States birth data. Plast Reconstr Surg. 2022;149(1):169-182. doi:https://doi.org/10.1097/PRS.0000000000008636
KruppaKKrugerEVorsterCder LindeJV. Cleft lip and/or palate and associated risks in lower-middle-income countries: A systematic review. Cleft Palate Craniofac J. 2022;59(5):568-576. doi:https://doi.org/10.1177/10556656211018952
13.
YangJCarmichaelSLCanfieldMSongJShawGM. National birth defects prevention S. Socioeconomic status in relation to selected birth defects in a large multicentered US case-control study. Am J Epidemiol. 2008;167(2):145-154. doi:https://doi.org/10.1093/aje/kwm283
14.
PawlukMSCampanaHRittlerM, et al.Individual deprivation, regional deprivation, and risk for oral clefts in Argentina. Rev Panam Salud Publica. 2018;41:e110. doi:https://doi.org/10.26633/RPSP.2017.110
15.
LupoPJDanyshHESymanskiELangloisPHCaiYSwartzMD. Neighborhood-Based socioeconomic position and risk of oral clefts among offspring. Am J Public Health. 2015;105(12):2518-2525. doi:https://doi.org/10.2105/AJPH.2015.302804
16.
PhillipsSHaucSCSassonDC, et al.Sociodemographic disparities in access to cleft rhinoplasty. J Craniofac Surg. 2023;34(1):92-95. doi:https://doi.org/10.1097/SCS.0000000000008908
17.
SmallridgeJWillsAKMahmoudO, et al.Centre-level variation in dental treatment and oral health and individual- and area-level predictors of oral health in 5-year-old children with non-syndromic unilateral cleft lip and palate: The cleft care UK study. Part 3. Orthod Craniofac Res. 2017;20(Suppl 2):19-26. doi:https://doi.org/10.1111/ocr.12185
18.
ChoaRMSlatorRJeremyA, et al.Identifying the effect of cleft type, deprivation and ethnicity on speech and dental outcomes in UK cleft patients: A multi-centred study. J Plast Reconstr Aesthet Surg. 2014;67(12):1637-1643. doi:https://doi.org/10.1016/j.bjps.2014.07.018
19.
SullivanZCVan EedenSMayJFlanniganNSeshuMDominguez-GonzalezS. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 2. Orthod Craniofac Res. 2022;25(1):103-111. doi:https://doi.org/10.1111/ocr.12504
20.
PfeifaufKDCooperDCGibsonE, et al.Factors contributing to delay or absence of alveolar bone grafting. Am J Orthod Dentofacial Orthop. 2022;161(6):820-828 e1. doi:https://doi.org/10.1016/j.ajodo.2021.01.033
21.
SinghGK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. Jul 2003;93(7):1137-1143. doi:https://doi.org/10.2105/ajph.93.7.1137
22.
Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry/Geospatial Research Analysis and Services Program. Data from: CDC/ATSDR Social Vulnerability Index 2018 Database US. 2018.
23.
SrivastavaTSchmidtHSadeckiEKornidesML. Disadvantage indices deployed to promote equitable allocation of COVID-19 vaccines in the US: A scoping review of differences and similarities in design. JAMA Health Forum. 2022;3(1):e214501. doi:https://doi.org/10.1001/jamahealthforum.2021.4501
24.
CarmichaelHMooreAStewardLVelopulosCG. Disparities in emergency versus elective surgery: Comparing measures of neighborhood social vulnerability. J Surg Res. 2020;256:397-403. doi:https://doi.org/10.1016/j.jss.2020.07.002
25.
KaalundKThoumiABhavsarNALabradorACholeraR. Assessment of population-level disadvantage indices to inform equitable health policy. Milbank Q. 2022;100(4):1028-1075. doi:https://doi.org/10.1111/1468-0009.12588
26.
KindAJJencksSBrockJ, et al.Neighborhood socioeconomic disadvantage and 30-day rehospitalization: A retrospective cohort study. Ann Intern Med. 2014;161(11):765-774. doi:https://doi.org/10.7326/M13-2946
27.
KindAJHBuckinghamWR. Making neighborhood-disadvantage metrics accessible - the neighborhood atlas. N Engl J Med. 2018;378(26):2456-2458. doi:https://doi.org/10.1056/NEJMp1802313
28.
University of Wisconsin School of Medicine and Public Health. Area Deprivation Index version 3.1. 2019.
29.
MearaJGHughesCDSanchezKCatallozziLClarkRKummerAW. Optimal outcomes reporting (OOR): A new value-based metric for outcome reporting following cleft palate repair. Cleft Palate Craniofac J. 2021;58(1):19-24. doi:https://doi.org/10.1177/1055665620931708
30.
TandonDSkolnickGBNaidooSD, et al.Morphologic severity of craniosynostosis: Implications for speech and neurodevelopment. Cleft Palate Craniofac J. 2021;58(11):1361-1369. doi:https://doi.org/10.1177/1055665620984643
31.
PatelKBPfeifaufKDSnyder-WarwickA. Family-Centered pediatric plastic surgery care. Mo Med. 2021;118(2):124-129.
32.
R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2021. Https://www.R-Project.Org/.
33.
BruneelLLuytenABettensK, et al.Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate. J Commun Disord. 2017;69(September):1-14. doi:https://doi.org/10.1016/j.jcomdis.2017.06.010
34.
RomeoRRChristodoulouJAHalversonKK, et al.Socioeconomic Status and Reading disability: Neuroanatomy and plasticity in response to intervention. Cereb Cortex. 2018;28(7):2297-2312. doi:https://doi.org/10.1093/cercor/bhx131
35.
QuayLCBlaneyRL. Verbal communication, nonverbal communication, and private speech in lower and middle socioeconomic status preschool children. J Genet Psychol. 1992;153(2):129-138. doi:https://doi.org/10.1080/00221325.1992.10753708
36.
Gonzalez-GomezNO'BrienFHarrisM. The effects of prematurity and socioeconomic deprivation on early speech perception: A story of two different delays. Dev Sci. 2021;24(2):e13020. doi:https://doi.org/10.1111/desc.13020
37.
RoweML. Child-directed speech: Relation to socioeconomic status, knowledge of child development and child vocabulary skill. J Child Lang. 2008;35(1):185-205. doi:https://doi.org/10.1017/s0305000907008343
38.
SchwabJFLew-WilliamsC. Language learning, socioeconomic status, and child-directed speech. Wiley Interdiscip Rev Cogn Sci. 2016;7(4):264-275. doi:https://doi.org/10.1002/wcs.1393
39.
SchererNJD'AntonioLLMcGaheyH. Early intervention for speech impairment in children with cleft palate. Cleft Palate Craniofac J. 2008;45(1):18-31. doi:https://doi.org/10.1597/06-085.1
40.
SouthbyLHardingSDaviesALaneHChandlerHWrenY. Parent/caregiver views of the effectiveness of speech-language pathology for children born with cleft palate delivered via telemedicine during COVID-19. Lang Speech Hear Serv Sch. 2022;53(2):307-316. doi:https://doi.org/10.1044/2021_LSHSS-21-00071
41.
VaragurKMurphyJOchoaE, et al.Impact of neighborhood deprivation and social vulnerability on long-term outcomes and desire for revision in patients with craniosynostosis. J Neurosurg Pediatr. 2023;32(3):257. doi: https://doi.org/10.3171/2023.4.PEDS2343
42.
CavalheiroMGLamonicaDACde Vasconsellos HageSRMaximinoLP. Child development skills and language in toddlers with cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2019 Jan;116:18-21. doi:https://doi.org/10.1016/j.ijporl.2018.10.011
43.
AdamsonCLAndersonVANopoulosPSealMLCostaDCA. Regional brain morphometric characteristics of nonsyndromic cleft lip and palate. Dev Neurosci. 2014;36(6):490-498. doi:https://doi.org/10.1159/000365389
44.
Seto-SalviaNStanierP. Genetics of cleft lip and/or cleft palate: Association with other common anomalies. Eur J Med Genet. 2014;57(8):381-393. doi:https://doi.org/10.1016/j.ejmg.2014.04.003
SimonAEPastorPNAvilaRMBlumbergSJ. Socioeconomic disadvantage and developmental delay among US children aged 18 months to 5 years. J Epidemiol Community Health. 2013;67(8):689-695. doi:https://doi.org/10.1136/jech-2013-202610
47.
Barnard-BrakLMorales-AlemanMMTomenyKMcWilliamRA. Rural and racial/ethnic differences in children receiving early intervention services. Fam Community Health. 2021;44(1):52-58. doi:https://doi.org/10.1097/FCH.0000000000000285
48.
BurkettKPicklerRBowersKFolkerAE. Disparities affect developmental risk for head start preschoolers. J Pediatr Nurs. 2020;54:86-92. doi:https://doi.org/10.1016/j.pedn.2020.06.010
49.
GovenderPGovenderVNaidooD. Developmental delay in a resource-constrained environment: An approach to early intervention. S Afr Fam Pract (2004). 2021;63(1):e1-e4. doi:https://doi.org/10.4102/safp.v63i1.5355
50.
GovenderVNaidooDGovenderP. Developmental delay in a resource-constrained environment: Screening, surveillance and diagnostic assessment. S Afr Fam Pract (2004). 2021;63(1):e1-e4. doi:https://doi.org/10.4102/safp.v63i1.5306
51.
GulsrudACarrTWilliamsJ, et al.Developmental screening and early intervention in a childcare setting for young children at risk for autism and other developmental delays: A feasibility trial. Autism Res. 2019;12(9):1423-1433. doi:https://doi.org/10.1002/aur.2160
52.
ShinJYNguyenSD. The effects of a home-based intervention conducted by college students for young children with developmental delays in Vietnam. Int J Dev Disabil. 2017;63(2):110-123. doi:https://doi.org/10.1080/20473869.2016.1144316
53.
HuntingtonNHoranKEpee-BounyaASchonwaldA. Developmental screening with Spanish-speaking families in a primary care setting. Clin Pediatr (Phila). 2016;55(4):347-355. doi:https://doi.org/10.1177/0009922815591884
54.
BevanSLLiuJWallisKEPinto-MartinJA. Screening instruments for developmental and behavioral concerns in pediatric hispanic populations in the United States: A systematic literature review. J Dev Behav Pediatr. 2020;41(1):71-80. doi:https://doi.org/10.1097/DBP.0000000000000724
55.
Hernandez-MekonnenRDugganEKOliveros-RosenL, et al.Health literacy in unauthorized Mexican immigrant mothers and risk of developmental delay in their children. J Immigr Minor Health. 2016;18(5):1228-1231. doi:https://doi.org/10.1007/s10903-015-0284-z
56.
AbbottMMKokorowskiPJMearaJG. Timeliness of surgical care in children with special health care needs: Delayed palate repair for publicly insured and minority children with cleft palate. J Pediatr Surg. 2011;46(7):1319-1324. doi:https://doi.org/10.1016/j.jpedsurg.2010.10.002
WagnerCZimmermanCEBarreroC, et al.Reduced socioeconomic disparities in cleft care after implementing a cleft nurse navigator program. Cleft Palate Craniofac J.2022;59(3):320-329. doi:https://doi.org/10.1177/10556656211005646
59.
CooperDCPetersonECGrellnerCG, et al.Cleft and craniofacial multidisciplinary team clinic: A Look at attrition rates for patients with complete cleft lip and palate and nonsyndromic single-suture craniosynostosis. Cleft Palate Craniofac J. 2019;56(10):1287-1294. doi:https://doi.org/10.1177/1055665619856245
60.
BuvikABergmoTSBuggeESmaabrekkeAWilsgaardTOlsenJA. Cost-Effectiveness of telemedicine in remote orthopedic consultations: Randomized controlled trial. J Med Internet Res. 2019;21(2):e11330. doi:https://doi.org/10.2196/11330
61.
DixonMJMarazitaMLBeatyTHMurrayJC. Cleft lip and palate: Understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167-178. doi:https://doi.org/10.1038/nrg2933
62.
VieiraAR. Genetic and environmental factors in human cleft lip and palate. Front Oral Biol. 2012;16:19-31. doi:https://doi.org/10.1159/000337521
63.
HongYXuXLianFChenR. Environmental risk factors for nonsyndromic cleft lip and/or cleft palate in Xinjiang province, China: A multiethnic study. Cleft Palate Craniofac J. 2021;58(4):489-496. doi:https://doi.org/10.1177/1055665620956869
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