Outcomes Amidst Adversity: Socioeconomic Factors in Cleft Lip and Palate Care in the Southern United States

Abstract

Objective

To evaluate socioeconomic and geospatial factors at a cleft care center in the Southern United States and assess their impact on outcomes in patients with cleft lip and/or palate (CLP).

Design

Retrospective chart review of patients with CLP, with stratification by neighborhood disadvantage using the University of Wisconsin's Area Deprivation Index (ADI). Univariate analyses compared quartiles.

Setting

A cleft care center in the Southern United States.

Patients, Participants

Inclusion criteria included children with CLP born between 2011 and 2022 who received the entirety of their care at the institution. Exclusion criteria were patients without CLP, those born before 2011, or those who did not complete care at the institution.

Interventions

No interventions were introduced.

Main Outcome Measure(s)

Associations between ADI quartiles and sociodemographic factors, appointment adherence, clinic presentation, hypernasality, and speech surgery incidence.

Results

Significant associations were identified between the most disadvantaged quartile and others for ethnicity (P < .001), primary language (P = .013), insurance status (P = .001), and household income (P < .001). The most disadvantaged quartile had fewer cancellations (P = .002) and presented earlier (P = .050), but had higher rates of hypernasality (P = .005) and speech surgery (P = .046).

Conclusions

Patients in the most disadvantaged quartile demonstrated strong adherence despite socioeconomic and linguistic barriers but had worse speech outcomes. Findings highlight opportunities to address linguistic and cultural barriers to improve cleft care.