{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:11:17Z","timestamp":1788667877299,"version":"build-2803163510"},"reference-count":91,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"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":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the prevalence, access to care, and health outcomes of orofacial clefts (OFCs) among American Indian and Alaska Native (AI\/AN) populations through a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis performed in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251035364).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>US-based population registries, hospital databases, and institutional or community-level retrospective studies involving AI\/AN populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Participants<\/jats:title>\n                    <jats:p>AI\/AN individuals with OFCs compared with non-Hispanic White patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Primary cleft lip and palate repair, secondary cleft-related procedures, and multidisciplinary cleft care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Prevalence of OFCs, timing of cleft surgery, discharge disposition, access to specialists, and qualitative determinants of disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen studies including more than 1985 AI\/AN patients were identified. Meta-analysis of 5 studies estimated a pooled OFC prevalence of 15 per 10\u2005000 live births (95% confidence interval: 5-49), with substantial heterogeneity (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999.8%). Individual studies reported significantly higher OFC prevalence in AI\/AN populations compared to non-Hispanic Whites (odds ratio range: 1.44-2.68). Geographic maldistribution of craniofacial-trained surgeons, increased odds of nonhome discharge, and delayed cleft palate repair were consistently observed barriers. Qualitative analyses highlighted structural inequities, perceived racism, and lack of culturally responsive care as major contributors to disparities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI\/AN populations face a disproportionately high burden of OFCs alongside structural barriers to timely, culturally competent care. Addressing these disparities requires community-engaged, multidisciplinary interventions that improve geographic access and integrate culturally responsive approaches to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261418392","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:50:12Z","timestamp":1772038212000},"page":"3565-3576","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Orofacial Cleft Disparities in American Indian and Alaska Native Populations: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"63","author":[{"given":"Lyndsay A.","family":"Kandi","sequence":"first","affiliation":[{"name":"University of Chicago Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3375-3818","authenticated-orcid":false,"given":"Antoinette T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4915-453X","authenticated-orcid":false,"given":"Jason","family":"Zhang","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8396-3063","authenticated-orcid":false,"given":"Nikhil","family":"Sriram","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9552-6483","authenticated-orcid":false,"given":"Robert D.","family":"Galiano","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7342-0917","authenticated-orcid":false,"given":"Arun K.","family":"Gosain","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000006655"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jds.2025.02.008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211042162"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007988"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231187291"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231189940"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211069828"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004813"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12925"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-071723-110657"},{"issue":"12","key":"e_1_3_2_12_2","first-page":"1","article-title":"Mortality profile of the non-Hispanic American Indian or Alaska Native population, 2019","volume":"70","author":"Arias E","year":"2021","unstructured":"Arias E, Xu J, Curtin SC, , Bastian B, , Tejada-Vera B. 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