81. Outcomes Amidst Adversity: Socioeconomic Factors in Cleft Lip/Palate Care in the Southern United States

PURPOSE: Neighborhood disadvantage has significant impacts on outcomes especially in patients with cleft lip and/or palate due to the longitudinal nature of their care. Previous studies demonstrated that the Southern United States has the lowest number of children living near a certified cleft care center. The purpose of this study was to evaluate socioeconomical and geospatial data as well as outcomes and interventions against neighborhood disadvantage scores specifically in the Southern United States. METHODS: A single-center retrospective analysis of patients with CLP was conducted. Inclusion criteria included all patients who received CLP care at the host institution born between 2011-2022. Exclusion criteria included patients without CLP, patients born prior to 2011, and patients who did not begin or continue the entirety of their CLP care at the host institution. Neighborhood disadvantage was determined using the University of Wisconsin’s Area of Deprivation Index (ADI) scored on the patient’s 9-digit zip code by national percentiles. Patients were divided into quartiles by ADI scores. Demographics, outcomes, and interventions were collected by retrospective analysis of patient charts. Univariate analysis of this data was compared between the most deprived ADI quartile and all other quartiles. RESULTS: A total of 406 patients met the inclusion requirements. There were no significant differences between the most deprived quartile and all other quartiles for sex, race, syndromic status, or CLP phenotype and laterality. Significant relationships between the most deprived quartile and all other quartiles prevailed for ethnicity (p<0.001), primary language (p=0.013), insurance status (p=0.001), and median household income (p<0.001). There was no significant difference between the two groups of quartiles for following up to age 5, quantity of no-shows, distance to care center, age at primary repair, or age at speech surgery. The most disadvantaged quartile had significantly less cancellations (p=0.002) and presented to clinic earlier (p=0.050), but a greater percentage of hypernasality (p=0.005) and incidence of speech surgery (p=0.046). CONCLUSION: This data provides insight into cleft care outcomes in the Southern United States, the region of the US that has historically had the least access to cleft care centers. The patients with the highest level of neighborhood disadvantage do not differ from the patients with less disadvantage in many interventional aspects and adherence with follow up to care. In fact, the patients in the most disadvantaged quartile have significantly less cancellations despite obstacles to care such as language, insurance, and economic differences. However, they have more undesirable outcomes such as hypernasality and incidence of speech surgery. Future research should expand on these findings across different regions of the US to pinpoint which variable might be most advantageous for public health initiatives to target in specific geographical locations.