Socioeconomic Disparities in Cleft Lip Care
Christopher L. Kalmar, Elizabeth Malphrus, Mychajlo S. Kosyk, Zachary D. Zapatero, Jesse A. Taylor
Abstract
Objective The purpose of this study was to utilize a multicenter dataset to elucidate whether socioeconomic factors were associated with access to cleft lip surgery, treatment by higher-volume providers, and family choice for higher-volume centers. Design Retrospective cohort study. Setting Hospitals participating in the Pediatric Health Information System. Patients Primary cleft lip repair performed in the United States between 2010 and 2020. Outcomes Travel distance, hospital volume, hospital choice. Results During the study interval, 8954 patients underwent unilateral (78.4%, n = 7021) or bilateral (21.6%, n = 1933) primary cleft lip repair. Patients with unilateral cleft lip were repaired significantly earlier if they were White ( P < .001) and significantly later if they lived in an urban community ( P = .043). Similarly, patients with bilateral cleft lip were repaired significantly earlier if they were White ( P < .001). Patients from above-median income households ( P = .011) and living in urban communities ( P < .001) were significantly more likely to be treated at high-volume hospitals, whereas those living in underserved communities ( P < .001) were significantly less likely to be treated at high-volume hospitals. White patients were significantly more likely to be treated by high-volume surgeons ( P < .001). Patients with White race were significantly more likely to choose a higher-volume hospital than the one most locally available ( P < .001). Conclusions Patients with White race are more likely to travel farther and be treated by high-volume surgeons although at smaller hospitals. Patients from underserved areas travel significantly farther for cleft care and are treated at lower-volume hospitals. Patients in urban communities have shorter travel distances and are treated at higher-volume hospitals.