A Geospatial Analysis of Barriers to Cleft Lip and Palate Care in the United States.

Autor:	Heron MJ; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Rezwan SK; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Zhu KJ; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Gornitsky J; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Redett RJ; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Yang R; Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association [Cleft Palate Craniofac J] 2024 Jun 05, pp. 10556656241259883. Date of Electronic Publication: 2024 Jun 05.
DOI:	10.1177/10556656241259883
Abstrakt:	Objective: This study evaluates the geospatial distribution of cleft lip and/or cleft palate (CL/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL/P care, and recommends interventions for improving access. Design: We identified American Cleft Palate Craniofacial Association-approved CL/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity. Results: We identified 187 CL/P teams in 45 states. Most were in the South (n = 60, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p < 0.01). Children without access in the South were 29% more likely to have a low birth weight and 46% more likely to be living below the poverty line (p < 0.01). Children with access were twice as likely to live in immigrant families and 7-times more likely to speak English as a second language. Conclusions: Pronounced disparities affect patients with and without one-hour access to CL/P care. Interventions should address care costs for patients living furthest without access and language barriers for patients with access that speak English as a second language. Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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