Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

Abstract

Background: Given the relatively resource-intensive burden of treating orofacial clefting and its functional and aesthetic sequelae, it is perhaps unsurprising that lower socioeconomic status is known to have adverse effects on outcomes in patients with cleft lip and/or palate (CL/P). Although outcomes in patients with CL/P are known to be influenced by socioeconomic status, the relationship between socioeconomic status and age-related weight gain has not been described. This study aimed to determine time-specific socioeconomic disparities in weight-for-age Z-scores and failure to thrive in patients with CL/P. Methods: This retrospective study evaluated patients presenting with CL/P from 2009 to 2019 at a tertiary children’s hospital. Failure to thrive status was determined by weight-for-age Z-scores less than −2.00 (second percentile) or from the EHR. Median income by block group was determined from US 2019 census data. Results: Multivariate linear regression models controlled for syndromic status, sex, and race revealed significant associations between median block group income and weight-for-age Z-scores at 4 weeks (β = .14, P = .009), 6 weeks (β = .15, P = .003), and 8 weeks (β = .14, P = .002). Mann Whitney U tests revealed significantly different weight-for-age Z-scores between low-income and high-income groups at 4 weeks ( P = .002), 6 weeks ( P < .001), 8 weeks ( P < .001), 10 weeks ( P = .005), and 12 weeks ( P = .004). Conclusions: Patients with CL/P and lower socioeconomic status may be most susceptible to disparities in weight gain between 4 and 8 weeks of age. Lower socioeconomic status was an independent predictor of failure to thrive for patients with CL/P in this cohort. This study highlights a welcome opportunity for timed intervention in patients with CL/P and lower socioeconomic status.