Residual Orofacial-Cleft Burden After Incidence Adjustment is Not a Treatment-Gap Measure: A Methodological Examination of GBD 2023

Global Burden of Disease (GBD) analyses of orofacial clefts often treat modeled disability-adjusted life-year (DALY) rates or quality-of-care indices as representing untreated disease or care quality. We tested whether an incidence-adjusted residual of GBD 2023 cleft estimates can support the reading for the craniofacial program targeting. Age-standardized estimates for 204 locations (1990–2023) were linked to World Bank indicators. The residual was the ordinary least squares remainder from a quadratic in year and World Bank region, fitted to log DALY rate on log incidence, using 6800 country-years (200 countries). The residual is not a validated measure of health-system or surgical access. A country-level age-matched residual could not be computed from the GBD country extract. Adding log incidence raised R 2 from 0.491 to 0.551 (incremental R 2 =0.060). The incidence coefficient was 0.723 (country-clustered 0.408–1.038; P =0.084 versus 1). In 2023, the SD of log incidence was 0.355 against 0.821 for log DALY rate, and 2.472 for log years of life lost (YLL) against 0.466 for log years lived with disability (YLD). Country order changed with grouping (Pearson r =0.62): Türkiye’s residual was 0.96 under World Bank Europe and Central Asia, versus −0.22 under GBD North Africa and the Middle East. The 2023 equal-country and population-weighted GDP gaps were 0.445 and 0.103 ( P =0.312). India held 49.1% of the poorest GDP quartile’s population. GBD-derived residuals should not be used as treatment-gap or surgical-access measures.