Global, regional and national burden of orofacial clefts from 1990 to 2021: Analysis of risk factors and prediction of trends in 2035

Orofacial clefts (OFCs) are common congenital anomalies with substantial health and social consequences, particularly where access to surgery and longitudinal care is limited. Burden varies across regions and socioeconomic strata. Using Global Burden of Disease 2021 estimates, we analyzed OFC incidence, prevalence, mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs) from 1990 to 2021 at global, regional, and national levels. Analyses were stratified by Socio-demographic Index (SDI) quintiles and World Bank regions. We applied autoregressive integrated moving average models to project prevalence and DALY trends to 2035. In 2021, OFCs affected an estimated 4.12 million individuals worldwide, with an age-standardized DALY rate of 5.18 per 100,000 population. The highest burdens were observed in Oceania, Western sub-Saharan Africa, and South Asia - regions predominantly in the lower SDI strata. Projections indicate gradual global reductions in prevalence and DALY rates through 2035; however, declines are expected to proceed more slowly in high-SDI regions than in low-SDI regions. OFCs remain a notable global health burden with marked geographic and socioeconomic disparities. Priorities include expanding access to timely surgical repair and multidisciplinary follow-up, strengthening public health outreach, and embedding psychosocial support - particularly in low-SDI settings.