Varagur K, Murphy J, Skolnick GB, Naidoo SD, Grames LM, Dunsky KA, Menezes M, Snyder-Warwick AK, Patel KB. Impact of Neighborhood Deprivation and Social Vulnerability on Outcomes and Interventions in Patients with Cleft Palate.
Cleft Palate Craniofac J 2024:10556656231226070. [PMID:
38196266 DOI:
10.1177/10556656231226070]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE
To examine whether neighborhood disadvantage impacts length of follow-up, interventions, and outcomes for patients with cleft palate.
DESIGN
Retrospective cohort.
SETTING
Cleft Palate Craniofacial Institute Database at St. Louis Children's Hospital.
PATIENTS/PARTICIPANTS
Patients with cleft palate following in St. Louis Children's Hospital Cleft Palate Multidisciplinary Team Clinic.
INTERVENTIONS
Primary palatoplasty between 2012-2017. Patients were divided into quartiles across area deprivation index (ADI) and social vulnerability index (SVI), two validated, composite metrics of neighborhood disadvantage, to examine whether living in neighborhoods from different deprivation quartiles impacts outcomes of interest.
MAIN OUTCOME MEASURE
Follow-up through age 5, surgeries and surgical complications, speech, developmental, and behavioral outcomes.
RESULTS
205 patients were included. 39% of patients belonged to the most deprived ADI quartile, while 15% belonged to the most vulnerable SVI quartile. There were no differences between ADI or SVI quartiles in number of operations received (p ≥ 0.40). Patients in the most deprived ADI quartile were significantly more likely to have speech/language concerns (OR 2.32, 95% CI [1.20-4.89], p = 0.01). Being in a more vulnerable SVI quartile was associated with developmental delay (OR 2.29, 95% CI [1.04-5.15], p = 0.04). ADI and SVI quartile did not impact risk of loss to follow-up in the isolated and combined cleft lip and palate subgroups (p ≥ 0.21).
CONCLUSIONS
Neighborhood disadvantage impacts speech and developmental outcomes in patients with cleft palate despite comparable length of follow-up in multidisciplinary team clinic.
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