91. Evaluating The Impact of Food Security on Children With Orofacial Clefts: An 8-year Review of the Global Burden of Disease Study

PURPOSE: Surgical ineligibility from malnutrition disproportionately affects children of low- and middle-income countries with orofacial clefts (OFCs). In addition to feeding difficulties associated with OFCs, low food security (FS) - defined as access to sufficient and nutritious food - prevents patients from reaching weight goals. Programs to improve global FS have been implemented, but the effects of higher FS in patients with OFCs are not well-understood. Our team therefore conducted a study to explore the relationship between FS and health outcomes in children with OFCs. We hypothesized that higher FS was associated with lower OFC-specific mortality, prevalence, and disability-adjusted life years (DALYs). METHODS: De-identified data were obtained from the Global Burden of Disease Study (GBD) and the Global Food Security Index (GFSI). We extracted geographic data (country, GBD region, & GBD super region); patient demographics (age category & sex); OFC-specific health outcomes (number of deaths in patients with OFCs, prevalence of OFCs, & DALYs in patients with OFCs per 100,000 population); and FS data. The GBD classifies 204 countries into 21 GBD regions (i.e. Western Africa, Southern Africa, High-Income Asia Pacific, etc.) and 7 GBD super regions (i.e. Sub-Saharan Africa, South Asia, High-Income, etc.) using geographic proximity and epidemiologic similarity. FS was reported on a 1-100 scale, with 100 indicating the highest FS. We included children < 4 years old with isolated cleft palate or cleft lip with or without cleft palate. Analyses included descriptive statistics, bivariate analyses, a zero-inflated negative binomial regression with mixed effects for deaths, and generalized estimating equations for prevalence and DALYs. Statistical significance was set at p < 0.05. RESULTS: Data were collected from 113 countries across 8 years (2012-2019). The South Asia GBD region had the highest number of deaths (median 1.1 deaths [IQR 0.3, 4.8]), the highest prevalence (median 5,628.4 cases [IQR 2,350.8, 14,489.7]), and the highest DALYs (median 638.5 DALYs [IQR 246.5, 2,273.8]) per 100,000 population. The Sub-Saharan Africa GBD super region had the lowest FS score (45.1 [IQR 42.0, 48.0]). Regression analysis showed that a 1-point increase in FS score was associated with a 13.8% decrease in the rate of deaths (incidence rate ratio 0.862 [95% CI 0.852, 0.871]) and a 74.9% increase in the odds of non-death (odds ratio 1.749 [95% CI 1.106, 2.786]) per 100,000 population. There was a negative linear relationship between FS and OFC prevalence (ß -18.5 OFC cases per 100,000 population [95% CI -34.8, -2.3]). Similarly, FS was negatively associated with DALYs (ß -43.1 DALYs per 100,000 population [95% CI -62.6, -23.5]). CONCLUSION: Higher FS was associated with reduced OFC-specific deaths, prevalence, and DALYs in children < 4 years old. Current efforts to improve global FS may result in better health outcomes in children with OFCs and should continue to be supported.