{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:58:24Z","timestamp":1781863104364,"version":"3.54.5"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe temporal trends in hospital admissions for cleft lip and\/or palate (CL\/P) repair in Brazil, assess the COVID-19 pandemic impact, examine racial and demographic disparities in length of hospital stay (LOS), and identify regional efficiency patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective ecological study using nationwide hospital admission data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Brazilian Unified Health System (SUS), covering public sector inpatient procedures. Participants: 98,998 hospital admissions for CL\/P surgical repair from 2008 to 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None (observational analysis of primary\/secondary surgical repairs). Main Outcome Measures: Annual admission volumes and trends (annual percent change via Prais\u2013Winsten regression); LOS by race\/color (Kruskal\u2013Wallis test); state-level clustering (K-means) based on volume, sex distribution, and mean LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Male predominance (ratio 1.36:1); 70% repairs under age 5. Stable volumes until 33% decline in 2020, with incomplete recovery. Significant racial disparities in LOS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.0007), longer among Brown (Parda) and Indigenous children. Heterogeneous state trends; four clusters identified, with S\u00e3o Paulo high-volume\/moderate-stay vs. northern low-volume\/prolonged-stay.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Brazil has robust CL\/P surgical capacity, but racial and profound regional disparities persist, compromising equity and efficiency. Targeted investment in northern regions, decentralized expertise, and standardized protocols are needed to reduce inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261458050","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:26:37Z","timestamp":1781529997000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Admissions for Cleft Lip and Palate in Brazil (2008\u20132024): Temporal Trends, Racial Disparities, and Regional Efficiency Clusters"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9185-0186","authenticated-orcid":false,"given":"Lariza Kelyana","family":"Cerqueira Da Silva","sequence":"first","affiliation":[{"name":"School of Odontology, Bahia College of Technology and Sciences, Alagoinhas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8880-4112","authenticated-orcid":false,"given":"Gabriel Kaleb","family":"Martins","sequence":"additional","affiliation":[{"name":"Medical Education Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211048415"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231181007"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60690-1"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007137"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36865"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/gepi.22158"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003509"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009634"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221078151"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2018.09.020"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215162"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619882566"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14214"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0335400"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph22070995"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241249821"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221150291"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211065187"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241259890"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011203"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261458050","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656261458050","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261458050","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:48:18Z","timestamp":1781862498000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656261458050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":20,"alternative-id":["10.1177\/10556656261458050"],"URL":"https:\/\/doi.org\/10.1177\/10556656261458050","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"article-number":"10556656261458050"}}