{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:29:09Z","timestamp":1790998149904,"version":"4.1.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Recent investigations focused on health equity have enumerated widespread disparities in cleft and craniofacial care. This review introduces a structured framework to aggregate findings and direct future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review was performed to identify studies assessing health disparities based on race\/ethnicity, payor type, income, geography, and education in cleft and craniofacial surgery in high-income countries (HICs) and low\/middle-income countries (LMICs). Case reports and systematic reviews were excluded. Meta-analysis was conducted using fixed-effect models for disparities described in three or more studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>N\/A<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Patients with cleft lip\/palate, craniosynostosis, craniofacial syndromes, and craniofacial trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>N\/A<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred forty-seven articles were included (80% cleft, 20% craniofacial; 48% HIC-based). Studies in HICs predominantly\n                      <jats:italic>described<\/jats:italic>\n                      disparities (77%,) and in LMICs focused on\n                      <jats:italic>reducing<\/jats:italic>\n                      disparities (42%). Level II-IV evidence replicated delays in cleft repair, alveolar bone grafting, and cranial vault remodeling for non-White and publicly insured patients in HICs (Grades A-B). Grade B-D evidence from LMICs suggested efficacy of community-based speech therapy and remote patient navigation programs. Meta-analysis demonstrated that Black patients underwent craniosynostosis surgery 2.8 months later than White patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and were less likely to undergo minimally-invasive surgery (OR 0.36,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delays in cleft and craniofacial surgical treatment are consistently identified with high-level evidence among non-White and publicly-insured families in HICs. Multiple tactics to facilitate patient access and adapt multi-disciplinary case in austere settings are reported from LMICs. Future efforts including those sharing tactics among HICs and LMICs hold promise to help mitigate barriers to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656241249821","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T08:55:12Z","timestamp":1714726512000},"page":"1294-1303","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Incomes to Outcomes: A Global Assessment of Disparities in Cleft and Craniofacial Treatment"],"prefix":"10.1177","volume":"62","author":[{"given":"Connor S.","family":"Wagner","sequence":"first","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3238-2907","authenticated-orcid":false,"given":"Michaela K.","family":"Hitchner","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5588-9279","authenticated-orcid":false,"given":"Natalie M.","family":"Plana","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie Z.","family":"Morales","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"},{"name":"Center for Surgical Health, Department of Surgery, Penn Medicine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren K.","family":"Salinero","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos E.","family":"Barrero","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Pontell","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott P.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-5471","authenticated-orcid":false,"given":"Jesse A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-8114","authenticated-orcid":false,"given":"Jordan W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006027"},{"issue":"29","key":"e_1_3_2_3_2","first-page":"1","article-title":"Race\/ethnicity, insurance, income and access to care: The influence of health status","volume":"12","author":"Wang T-F","year":"2013","unstructured":"Wang T-F, Shi L, Nie X, Zhu J. 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