Multi-institutional Socioeconomic Disparities Associated With Delayed Alveolar Bone Grafting in Patients With Cleft Lip and Palate
Hanna Pfershy, Rachel Lee, Elizabeth Bushong, Jonathan Richard, Ryan Badiee, Darin Patmon, Brooke Dudick, Anna Carlson, Jason Pomerantz, Gregory Fulton, John GirottoObjective
To determine how insurance status, institutional factors, and patient demographics affect the likelihood of timely alveolar bone grafting (ABG) in patients with cleft lip and/or palate across three geographically, demographically, and socioeconommically diverse US institutions.
Design
Retrospective cohort study.
Setting
Multi-institution.
Patients, Participants
All patients who received primary ABG across three institutions.
Interventions
None.
Main Outcome Measure(s)
Demographic data, insurance status, driving distance, and median income were collected. Age at ABG as a linear variable and as a binary variable of standard (<12 years) versus delayed (≥12 years) timing was analyzed using χ 2 , Wilcoxon rank-sum, and multiple logistic regression.
Results
A total of 587 patients were included in the analysis, 251 from Institution #1, 225 from Institution #2, and 111 from Institution #3. The average age at surgery was 10.52 years, 29% received ABG after age 12, and 44% had Medicaid insurance. Those with Medicaid had a higher proportion of delayed surgeries compared to those with private insurance (38% vs 22%,
Conclusions
Patients with Medicaid are more likely to receive alveolar bone graft after age 12, and wealth may be a predictor of timely care across three geographically distinct centers in the United States.