Purpose
Previous studies have demonstrated inequalities in both access and delivery of medical care based on patient demographics and geographic settings. Patients with orofacial clefts may be at particular risk for such challenges given the potential need for multiple treatment interventions over their lifetime. Therefore, we sought to determine whether such disparities exist in patients with cleft lip and/or palate (CL/P) based on national database data.
Methods
The 2019 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried using ICD-10 diagnosis codes for all patient entries with CL/P over the age of 2. These filtered entries were further assessed for co-existing active CL/P complications (all queried codes listed in Table 1). Cluster analysis was used to group subject entries (by hospital) based on different patient population and hospital characteristics (e.g., regional hospital location, rural/urban setting, bed size, patient demographic compositions). Logistic regression analysis was then used to estimate the probability a patient had active CL/P complication(s) as a function of the empirically grouped hospital type they were treated in.
Results
6 grouped hospital types were identified and clearly delineated by geographic region, urban-rural designation, and/or patient income level (Table 2). Higher-income urban areas had the lowest rate of active CL/P complications (10%, 95% CI [4%, 25%]) compared to the rural South (32%, [27%, 38%]) and lower-income urban areas (39%, [35%, 42%]) (both p ? 0.01) (Table 3).
Conclusion
Pediatric patients who live in urban, higher-income areas have lower rates of active CL/P complications compared to their lower-income urban counterparts and those who live in the rural South. This indicates a disparity in access to and/or delivery of longitudinal care for CL/P patients by geographic and income differences that can be effectively addressed through passage of federal legislation such as the Ensuring Lasting Smiles Act.
Table 1. ICD-10 Diagnosis Codes Used for Identifying CL/P Patients and Those with Active CL/P Complications
Table 2. Hospitals of CL/P Patient Entries Grouped by Cluster Analysis Based on Hospital and Patient Population Characteristics
Table 3. Average Rate of CL/P Patients with Active CL/P Complication(s) by Grouped Hospital Type
