Sociodemographic Disparities in Access, Timing, and Outcomes of Cleft Palate Repair in the United States

Purpose: The timing of cleft palate (CP) repair has been refined based on decades of study to optimize feeding, speech, and quality of life outcomes. However, sociodemographic disparities may impact accessibility of cleft care, surgical timing, and outcomes. This study reviews published data on sociodemographic disparities impacting primary CP repair access, timing, and outcomes in the United States. Methods: A systematic review was performed following PRISMA guidelines in the Pubmed, Embase, and Medline/OVID databases. Included studies focused on sociodemographic disparities in access to, timing, and outcomes after CP surgery. Studies performed outside the United States or published before 2000 were excluded. Results: Twenty-three studies were included in the review focusing on access to care (n = 8), financial cost (n = 1), surgical timing (n = 12), and surgical outcomes (n = 9). Access is most challenging for non-White patients and those with public insurance. Financial disparities are poorly studied and understood. Non-White, particularly Asian patients, those with public insurance, or geographically remote patients receive delayed care. The same populations struggle with obtaining quality outcomes. Government health policies or the provision of a cleft navigator can resolve disparities in surgical timing and potentially outcomes. Conclusions: Disparities in CP repair access and outcomes affect minority, particularly Asian, publicly insured, and geographically remote patients. The presence of a cleft navigator to help guide patients through the healthcare system can be effective. Future studies should aim to further investigate financial disparities and design initiatives that improve coordination of care for CP surgery in underserved populations.