Impact of Socioeconomic Indices on Completion of Cleft Lip and Palate Care.

Abstract

The impact of socioeconomic status on completion of cleft lip and palate (CLP) care is poorly understood. We examined the association between socioeconomic factors and both completion and timing of LeFort I advancement, one of the final surgeries in the cleft care pathway. We conducted a multi-institutional retrospective study of CLP patients > 18 years of age recommended for LeFort I advancement between 1991-2024. Addresses were geocoded and linked to four socioeconomic indices: Social Vulnerability Index, Vizient Vulnerability Index, Child Opportunity Index, and Area Deprivation Index. Multi-variable logistic regression models evaluated associations between socioeconomic indices and surgical completion. Multi-variable linear regression models assessed associations between scores and age at surgery among patients who completed LeFort I advancement surgery, adjusting for clinical severity, insurance, travel distance, distraction osteogenesis, and program engagement duration. Of the 184 CLP patients [median age at review 29.1 (IQR 20.4;32.3) years], 127 (69%) underwent LeFort I advancement and 57 (31%) did not complete surgery. Patients who did not undergo surgery demonstrated consistently greater vulnerability or lower opportunity across indices. Household composition vulnerability independently predicted foregoing surgery (adjusted OR 4.6-14.7 depending on geospatial scale, p<0.05). Among patients who underwent LeFort I, socioeconomic vulnerability was associated with older age at surgery. Transportation vulnerability, in particular, was found to independently delay surgery by 1.4-8.7 years per unit increase depending on index and geospatial scale, while greater neighborhood wealth was associated with earlier surgery. Socioeconomic disadvantage influences both completion and timing of LeFort I advancement.