Sociodemographic Factors Predict Long-Term Attrition from Multidisciplinary Cleft Clinic

Abstract

Objective

Identify and describe factors associated with retention and attrition of patients during longitudinal follow-up at multidisciplinary cleft clinic.

Design

Retrospective cohort study.

Setting

Single, tertiary care center.

Patients, Participants

Patients born between 1995 and 2007 with a diagnosis of cleft palate with or without cleft lip attending multidisciplinary cleft clinic.

Interventions

None tested, observational study.

Main Outcome Measure(s)

Age at last clinical appointment with a multidisciplinary cleft team provider. Attrition was defined as absence of an outpatient appointment following 15 years of age.

Results

Six hundred seventy-eight patients were included. The average age at last appointment across the entire cohort was 13.1 years (IQR 6.6–17.2). Patients who were Black (HR 1.60, 95% CI 1.10–2.32, p = 0.014) and other races (HR 1.90, 95% CI 1.22–2.98, p = 0.004) were more likely to be lost to follow-up compared to white patients. Publicly insured patients were more likely to experience attrition than those who were privately insured (HR 1.30, 95% CI 1.03–1.65, p = 0.030). Estimated income was not significantly associated with length of follow-up (p = 0.259). Those whose residence was in the fourth quartile of driving distance from our center experienced loss to follow-up significantly more than those who lived the closest (HR 2.04, 95% CI 1.50–2.78, p < 0.001).

Conclusions

There is a high degree of follow-up attrition among patients with cleft lip and palate. Race, insurance status, and driving distance to our center were associated with attrition in a large, retrospective cohort of patients who have reached the age of cleft clinic graduation.