Neighborhood Opportunity and Timing of Cleft Palate Repair: A Multicenter Pediatric Cohort Study

Objectives Delays in cleft palate repair are associated with worse functional outcomes. Although racial and ethnic disparities in surgery timing have been described, the influence of area-level social determinants of health remains unclear. We hypothesized that neighborhood opportunity is associated with delayed cleft palate repair. Design We conducted a retrospective cohort study using the Pediatric Health Information System including children undergoing primary cleft palate repair from 2014 to 2025. Neighborhood opportunity was categorized using Child Opportunity Index 3.0 quintiles. The primary outcome was delayed repair (>12 months). Multivariable generalized linear mixed models estimated adjusted risk ratios (aRRs) accounting for demographic and clinical factors. Results Among 9719 children (median age at repair, 11.6 months [IQR, 10.1-13.5]), 25.5% resided in very low-opportunity neighborhoods and 15.8% in very high-opportunity neighborhoods. In adjusted analyses, neighborhood opportunity was not associated with delayed cleft palate repair (very low vs very high opportunity: aRR, 1.11; 95% CI, 0.99-1.23; P = .09). In a sensitivity analysis, children in very low-opportunity neighborhoods underwent repair slightly later than those in very high-opportunity areas (adjusted mean difference, 0.28 months; 95% CI, 0.06-0.51; P = .01), corresponding to approximately 1 week and not clinically meaningful. Conclusions Neighborhood opportunity was not associated with clinically meaningful differences in the timing of cleft palate repair. These findings suggest that structured, multidisciplinary cleft care may mitigate the impact of social determinants of health on access to timely surgical repair.