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Surgical Workforce, Socioeconomic Status, and the Global Burden of Orofacial Clefts

Morrison, Shane D. MD, MS; Massenburg, Benjamin B. MD; Crowe, Christopher S. MD; Alonso, Nivaldo MD, PhD; Calis, Mert MD; Donkor, Peter MD; Kreshanti, Prasetyanugraheni MD; Yuan, Jie MD; Hopper, Richard A. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 62
doi: 10.1097/01.GOX.0000584564.56282.e4
Craniofacial Abstracts
Open

University of Washington, Seattle, WA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. Our hypothesis is that most of this burden falls on the countries with the smallest surgical workforce or lowest sociodemographic indices, rather than the countries with the highest prevalence of disease.

METHODS: The Global Burden of Disease methodology was used to estimate prevalence and morbidity of orofacial clefting in 195 countries from 1990 to 2017. Disability-adjusted life years (DALYs) and prevalence were compared over time, geographically, and against the sociodemographic index (SDI) and size of the national surgical workforce. Linear and logarithmic regressions were performed. Our international authorship hypothesizes on multiple factors contributing to this change based on their region’s perspective.

RESULTS: From 1990 to 2017, the number of clefts worldwide decreased by 4.9% to 10.8 million and the burden of this disease significantly decreased by 70.2% to 652,084 DALYs. In 2017, low- and middle-income countries experienced 83.5% of the DALY burden. The largest decreases in DALY were seen in East Asia and the Pacific (83.6% decrease) and Sub-Saharan Africa (73.1% decrease), whereas North America (14.2% decrease) and high-income countries (20.5% decrease) remained neutral. Prevalence was weakly positively associated with increasing SDI (r = 0.43; r2 = 0.18), whereas DALYs were negatively associated with SDI (r = −0.79; r2 = 0.48). There was a logarithmic association between the estimated surgical workforce and the disease burden, with significantly fewer DALYs in countries that had a surgical workforce of >6 providers per 100,000 population.

CONCLUSION: The burden of orofacial clefts has decreased significantly despite steady prevalence over the past 28 years. Most of the burden of orofacial clefting is carried by low- and middle-income countries, and the prevalence of orofacial clefting is not strongly correlated with the sociodemographic index. Strengthening the surgical workforce may aid in decreasing the life-long disease burden of orofacial clefting for any given country.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.