Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA.
Cleft Palate Craniofac J. 2024 Jun;61(6):921-929. doi: 10.1177/10556656221150291. Epub 2023 Feb 19.
Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes.
Retrospective review and outcomes analysis (n = 740).
Urban academic tertiary care center.
740 patients undergoing primary (CL/P) surgery from 2009 to 2019.
Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery.
Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, < 0.001). Lower patient median block group income predicted later age at cleft lip (β = -67.25, = 0.011) and cleft palate (β = -46.35, = 0.050) repair surgery.
Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.
确定影响唇裂和/或腭裂（CL/P）管理和结局的地理空间和社会经济因素之间的相互作用。
回顾性研究和结局分析（n=740）。
城市学术三级保健中心。
2009 年至 2019 年期间接受初次（CL/P）手术的 740 例患者。
整形外科的产前评估、鼻牙槽塑形、唇裂黏合术以及 CL/P 手术的年龄。
整形外科的产前评估受患者中值街区组收入较高和患者与保健中心距离较短的交互作用预测（OR=1.07，=0.022）。鼻牙槽塑形也受患者中值街区组收入较高和与保健中心距离较短的交互作用预测（OR=1.28，=0.016），而唇裂黏合术仅受患者中值街区组收入较高的预测（OR=0.41，<0.001）。患者中值街区组收入较低预测唇裂（β=-67.25，=0.011）和腭裂（β=-46.35，=0.050）修复手术的年龄较大。
距离保健中心的远近和街区组的中值收入相互作用，对位于大型城市三级保健中心的 CL/P 患者的整形外科产前评估和鼻牙槽塑形具有显著预测作用。离保健中心最远且接受整形外科产前评估或行鼻牙槽塑形的患者，其街区组收入中位数较高。未来的工作将确定持续存在这些护理障碍的机制。
