Quality of Life Impact of Velopharyngeal Insufficiency: The Role of Social Determinants of Health.

Abstract

The impact of velopharyngeal insufficiency (VPI) on patient and caregiver quality of life (QOL) is well documented. The social determinants of health (SDOH) that affect this relationship remain unclear. This study aimed to evaluate these associations to better understand how social context impacts patients and caregivers at risk of VPI due to congenital cleft and craniofacial deformities. Retrospective review of caregiver-reported Velopharyngeal Insufficiency Effects on Life Outcome (VELO) questionnaire responses was conducted for patients seen in a multidisciplinary cleft and craniofacial clinic from 2020 to 2023. Scores were matched to census data regarding educational opportunities, health/environmental factors, and socioeconomic factors using the Childhood Opportunity Index (COI). Associations between QOL and SDOH were evaluated via linear regression, with higher scores representing better values. Among the cohort (N = 161), multiple SDOH categories significantly predicted the QOL impacts of VPI (p < 0.05). Socioeconomic factors were positively correlated with speech limitations, situational difficulty, emotional impact, and caregiver impact (β = 0.23-0.36, p < 0.05). Contrary to our hypothesis, health/environmental factors exhibited a significant negative correlation across the same VELO domains in addition to swallowing problems (β = -0.29 to -0.12, p < 0.05). Educational opportunities showed no significant association with any VELO subcategory (β = -0.11 to -0.03, p > 0.1). Higher socioeconomic status was associated with better VELO scores, underscoring the protective role of resources in health outcomes and caregiver perceptions. In contrast, caregivers with better health/environmental conditions reported worse outcomes, suggesting that higher health standards may influence perceptions of VPI severity.