Disparities in Cleft Care for Hispanic/Latino Patients in the United States: A Systematic Review and Meta-Analysis.

Abstract

ObjectiveTo systematically evaluate disparities in access, timing, and outcomes of cleft care for Hispanic/Latino patients in the United States.DesignSystematic review and random-effects meta-analysis conducted per PRISMA guidelines (PROSPERO CRD420251053224).SettingUS-based studies using national databases, state registries, and institutional cohorts.Patients, ParticipantsHispanic/Latino children with cleft lip and/or palate compared to non-Hispanic White children.InterventionsPrimary cleft lip and palate repair and secondary cleft-related procedures, including alveolar bone grafting.Main Outcome Measure(s)Timing of surgical interventions, postoperative complications, mortality, hospital charges, secondary procedure utilization, and patient-reported outcomes.ResultsTwenty-eight studies encompassing 30,006 Hispanic/Latino patients met inclusion criteria. Eight studies addressed surgical timing: Hispanic/Latino patients had significantly delayed primary repairs (eg, adjusted hazard ratio [aHR] 0.90 for cleft lip repair; odds ratio [OR] 2.76 for delayed palate repair) and higher rates of bone grafting after age 12 (24.4% vs. 19.4%, P = .0049). Three studies reported mixed patterns of secondary procedure utilization, with underuse of some operations (OR 0.29 for higher surgery frequency) but overrepresentation in cleft rhinoplasty (OR 1.36). Two national datasets showed elevated cleft-related mortality (OR 1.54; HR 1.3-1.7). While postoperative complication rates were largely equivalent, Hispanic/Latino patients experienced longer hospital stays and higher charges in several analyses. Meta-analysis of 2 studies on delayed surgery yielded a pooled OR of 2.11 (95% confidence interval 0.23-19.80) with low heterogeneity but wide uncertainty.ConclusionsHispanic/Latino patients face multifaceted disparities in cleft care-particularly delayed surgery and fragmented follow up-despite comparable technical outcomes. Targeted interventions addressing structural, linguistic, and cultural barriers are needed to advance equity in cleft treatment.