Assistant Professor Weill Cornell Medicine Ithaca, New York, United States
Background: Isolated cleft palate (CLP) is a common birth defect that impacts the quality of life for many newborns and families requiring long-term multidisciplinary comprehensive clinical care. Previous population studies (ElHaweary et al, 2021) have reported decreasing incidence of palatoplasties, and data assessing recent CLP prevalence trends in the United States (US) is lacking. Objective: To report the current prevalence, trends and factors associated with isolated CLP during birth hospitalization. Design/Methods: Data was extracted from the CDC-WONDER natality dataset (2016-2022), compiled from the birth certificate data provided through the Vital Statistics Cooperative Program. Variables including sex, race, tobacco use, and US state of birth were collected. Prevalence data was presented per 1000 live births with Poisson distributed 95% confidence intervals (CI). We did a bivariate analysis to examine the racial disparities in prevalence and for trend analysis, we conducted joinpoint regression (National Cancer Institute, USA) to determine the annual percent changes (APC) with statistical significance set at p<.05. Results: From 2016 to 2022, out of 26,286,324 live births, 6134 (0.23%) infants were reported with diagnosis of isolated CLP. Median (IQR) prevalence was 0.27 (0.18, 0.36) with 11 fold variation across the states (Figure 1). Compared to White infants, CLP prevalence was higher in American Indians/Alaska Native (OR 2.0 [95% CI: 1.7-2.4]; p< .001) and lower in Asian (OR 0.70 [95%CI: 0.62-0.78]; p< .001), Black (OR 0.57 [95% CI: 0.53-0.62]; p< 0.001) infants (Figure 2). Prevalence decreased among Black infants (APC: -2.7 [95% CI: -7.1, 2.0], p=0.20) during the study period while statistically significant downward trend was observed among White infants between 2018 to 2022 (APC -2.2 [95% CI: -3.5, -0.8], p=0.02). Tobacco use was associated with two-fold increased odds of isolated cleft palate (OR 2.3 [95% CI: 2.1, 2.5], p<.001). Overall trend showed no significant change (APC -0.8 [95% CI: -1.9, 0.4], p=0.16) (Figure 3)
Conclusion(s): During past seven years, we found consistent downward trend in CLP prevalence and noted considerable variation in the rates across the United States. These findings may represent changing genetic or environmental risk factors and population demographics. Limitations include overreliance on birth certificate data which might underestimate true prevalence secondary to missing data or late diagnosis. Further research is needed to better understand definitive associations and etiologies of CLP.
