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. 2025 Jan 8;20(1):e0317267.
doi: 10.1371/journal.pone.0317267. eCollection 2025.

Global, regional, and national survey on burden and Quality of Care Index (QCI) of orofacial clefts: Global burden of disease systematic analysis 1990-2019

Ahmad Sofi-Mahmudi  1   2   3 , Erfan Shamsoddin  4 , Sahar Khademioore  2 , Yeganeh Khazaei  5 , Amin Vahdati  6 , Marcos Roberto Tovani-Palone  7
Affiliations

Global, regional, and national survey on burden and Quality of Care Index (QCI) of orofacial clefts: Global burden of disease systematic analysis 1990-2019

Ahmad Sofi-Mahmudi et al. PLoS One. .

Abstract

Background: Orofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels.

Objective: We aimed to measure the quality-of-care index (QCI) for orofacial clefts worldwide.

Methods: We used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios to indirectly reflect the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications.

Results: Globally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI = 99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimal gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world.

Conclusion: Despite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The temporal trend of the age-standardized QCI for orofacial clefts, presented as a percentage, is depicted for both genders from 1990 to 2019.
QCI: Quality of care index.
Fig 2
Fig 2
The geographical distribution of the Age-Standardized Gender Disparity Ratio (GDR) for lip and oral cavity cancer, comparing men and women in 1990 (Part A) and 2019 (Part B). GDR: Gender disparity ratio.
Fig 3
Fig 3. Global regions and countries listed in descending order based on their QCIs in 2019.
Fig 4
Fig 4
The geographic distribution of age-standardized Quality of Care Index (QCI) percentages for lip and oral cavity cancer in both men and women in 1990 (Part A) and 2019 (Part B). QCI: Quality of care index.
See this image and copyright information in PMC

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