Orofacial Cleft Disparities in American Indian and Alaska Native Populations: A Systematic Review and Meta-Analysis.
Lyndsay A Kandi, Antoinette T Nguyen, Jason Zhang et al.
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In 30 seconds
This systematic review and meta-analysis examined orofacial cleft prevalence, care access, and outcomes among American Indian and Alaska Native (AI/AN) populations in US-based studies. Eighteen studies included more than 1985 AI/AN patients. Across five studies, pooled prevalence was 15 per 10 000 live births (95% confidence interval: 5-49), with substantial heterogeneity (I² = 99.8%). Individual studies reported higher prevalence than among non-Hispanic White populations, while geographic maldistribution of specialists, delayed palate repair, and nonhome discharge were reported barriers. Qualitative findings identified structural inequities, perceived racism, and limited culturally responsive care.
Key findings
- Pooled orofacial cleft prevalence was 15 per 10 000 live births (95% confidence interval: 5-49) across five studies; heterogeneity was substantial (I² = 99.8%).
- Individual studies reported higher prevalence among AI/AN populations than non-Hispanic White populations, with odds ratios ranging from 1.44-2.68.
- Geographic maldistribution of craniofacial-trained surgeons, delayed cleft palate repair, and increased odds of nonhome discharge were reported barriers.
- Qualitative analyses identified structural inequities, perceived racism, and lack of culturally responsive care as contributors to disparities.
Why it matters
The review brings together evidence that disparities involve both disease burden and access to timely, culturally responsive care. Recognising geographic and structural barriers can inform efforts to assess how cleft services are organised and whether care pathways meet the needs of AI/AN communities. The substantial heterogeneity also underscores that prevalence estimates vary across the included studies.
What to keep in mind
The pooled prevalence estimate was based on five studies and had substantial heterogeneity (I² = 99.8%), limiting confidence in a single summary estimate.