Disparities in Surgical Intervention in Pediatric Patients With Submucous Cleft Palate and Velopharyngeal Dysfunction

Abstract

Objective: To evaluate factors impacting access to and timing of surgery in patients with submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD).

Study design: Retrospective cohort study.

Setting: Single academic medical center.

Methods: Patients with SMCP and VPD between 2004 and 2021 were identified. Variables included national and state area deprivation index (ADI) percentiles, child opportunity index (COI) categories, distance to care, and insurance status. χ², Fisher's exact test, Wilcoxon rank-sum, Spearman rank correlation, t test, and linear regression (α = .05) were used to investigate the relationships between these variables and surgical status and timing.

Results: A total of 168 patients were included, 94 surgical and 74 nonsurgical. Patients were predominantly white (160/168; 95.2%), Male (103/168; 61.3%), and non-Hispanic (153/168; 91.1%). There were no intergroup differences with respect to ADI, COI, insurance status, or distance from the hospital. Surgical patients were more likely to have overt SMCP (P = .03), earlier age at SMCP diagnosis (P = .02), and higher baseline Pittsburgh weighted speech score (PWSS) (P = <.001). In multivariable regression, younger age at surgery was found to be significantly associated with higher baseline PWSS (P = .001) and lower state ADI deciles (P = .03). Patients with private insurance had a lower baseline PWSS than those with public insurance (P = .04). Insurance status was not significantly associated with age at diagnosis (P = .79) or age at surgery (P = .08).

Conclusion: In this study, patients from less disadvantaged neighborhoods were found to have earlier surgical intervention, highlighting the importance of incorporating social determinants of health in the evaluation of VPD and SMCP patients to prevent treatment delays.

Keywords: area deprivation index; child opportunity index; disparities; submucous cleft palate; velopharyngeal dysfunction.

Figure 1

Surgical status and national ADI percentile. Box and whisker plot representation of national ADI percentile and surgical status, demonstrating no significant difference between surgically and nonsurgically managed patients (Wilcoxon rank‐sum P = .06) + indicates mean. ADI, area deprivation index.

Figure 2

Surgical status and childhood opportunity index. box and whisker plot representation of childhood opportunity index classification and surgical status demonstrating no significant difference between surgically and nonsurgically managed patients (Wilcoxon rank‐sum P = .9) + indicates mean.

Figure 3

Age at surgery and baseline PWSS. Graphical representation of the univariate association between age at surgery and PWSS, demonstrating decreased age at surgery in years with increasing baseline PWSS (Spearman rank correlation P < .001). PWSS, Pittsburgh weighted speech score.

Figure 4

Insurance status and baseline PWSS. Box and whisker plot representation of insurance status and PWSS demonstrating that patients with private insurance had significantly lower baseline PWSS compared to those with public insurance only (Wilcoxon rank‐sum P = .04) + indicates mean. PWSS, Pittsburgh weighted speech score.