目的:腭裂的延迟修复与较差的言语结局相关。健康的社会决定因素可能会影响手术的时机;然而,没有人口健康调查来评估旅行距离等因素,语言障碍,和付款人。这项研究试图找出可能干扰及时腭裂修复的因素。
方法:回顾性队列。
方法:国家/多中心。
方法:从2000-2021年提取了所有加利福尼亚州的left裂修复。
方法:主要结果是手术修复的年龄,用线性回归建模。协变量包括种族,主要语言,从病人家到医院的距离,社会经济地位,主要付款人,和管理式医疗登记状态。
结果:11260例患者接受了腭裂手术修复。黑人种族与延迟维修有关(另外22天,P=.004,95%CI67.00-37.7)以及亚洲/太平洋岛民种族(额外11天,与白种人相比,P=.006,95%CI3.26-18.9)。讲西班牙语的患者到19天明显推迟了腭裂修复,与讲英语的人相比(P<.001,95%CI10.8-27.7)。距离医院更远的距离与52天后接受手术的州外患者的术后裂隙手术显著相关(P<.001,95%CI11.3-24.3)。与私人保险相比,管理式护理计划和Medi-Cal与早期手术修复显着相关。
结论:黑色,亚洲太平洋岛民,和讲西班牙语的患者以及前往医院的更远的距离与腭裂修复延迟相关。这些结果强调了解决护理的结构和社会障碍的重要性,以改善结果并减少left裂患者的健康差异。
OBJECTIVE: Delayed repair of cleft palate is associated with worse speech outcomes. Social determinants of health may influence the timing of surgery; however, there are no population health investigations to evaluate factors such as travel distance, language barriers, and payer. This study sought to identify factors that may interfere with timely cleft palate repair.
METHODS: Retrospective cohort.
METHODS: National/multi-center.
METHODS: All cleft palate repairs within California were extracted from 2000-2021.
METHODS: The primary outcome was age at surgical repair, which was modeled with linear regression. Covariates included race, primary language, distance from patient home to hospital, socioeconomic status, primary payer, and managed care enrollment status.
RESULTS: 11 260 patients underwent surgical repair of a cleft palate. Black race was associated with delayed repair (22 additional days, P = .004, 95% CI 67.00-37.7) along with Asian/Pacific-Islander race (11 additional days, P = .006, 95% CI 3.26-18.9) compared to white race. Spanish-speaking patients had significantly later cleft palate repairs by 19 days, (P < .001, 95% CI 10.8-27.7) compared with English-speaking. Further distances from the hospital were significantly associated with later cleft surgeries with out-of-state patients undergoing surgery 52 days later (P < .001, 95% CI 11.3-24.3). Managed care plans and Medi-Cal were significantly associated with earlier surgical repair compared with private insurance.
CONCLUSIONS: Black, Asian Pacific Islander, and Spanish-speaking patients and greater distance traveled to hospital were associated with delayed cleft palate repairs. These results underscore the importance of addressing structural and social barriers to care to improve outcomes and reduce health disparities for patients with cleft palate.