Disparities in Cleft Care for Hispanic/Latino Patients in the United States: A Systematic Review and Meta-Analysis.
Antoinette T Nguyen, Rena A Li, Robert D Galiano et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined US studies comparing cleft care for Hispanic/Latino children with care for non-Hispanic White children. Across 28 studies encompassing 30,006 Hispanic/Latino patients, findings indicated delayed primary repairs and later alveolar bone grafting, alongside mixed patterns of secondary procedure use. Bone grafting after age 12 occurred in 24.4% versus 19.4% (P = .0049). Postoperative complication rates were largely comparable, although some analyses found longer hospital stays and higher charges. The pooled estimate for delayed surgery was imprecise, with an OR of 2.11 (95% confidence interval 0.23-19.80).
Key findings
- Hispanic/Latino patients had delayed primary repairs, including an adjusted hazard ratio of 0.90 for cleft lip repair and an OR of 2.76 for delayed palate repair.
- Alveolar bone grafting after age 12 was more frequent among Hispanic/Latino patients: 24.4% vs. 19.4% (P = .0049).
- Two national datasets reported elevated cleft-related mortality (OR 1.54; HR 1.3-1.7), while postoperative complication rates were largely equivalent.
- The pooled OR for delayed surgery was 2.11 (95% confidence interval 0.23-19.80), indicating substantial uncertainty.
Why it matters
The review identifies disparities in the timing and continuity of cleft care despite broadly comparable technical complication outcomes. Delayed procedures, variable use of secondary operations, and reported differences in mortality and resource use point to inequities extending beyond surgical performance. Recognising these patterns can inform efforts to assess access and follow-up barriers across cleft care pathways.
What to keep in mind
The pooled estimate for delayed surgery came from only 2 studies and had a wide confidence interval. Included evidence spanned national databases, state registries, and institutional cohorts, with mixed findings for secondary procedure use.