Global Burden of Orofacial Clefts and the World Surgical Workforce

Massenburg B.B. Hopper R.A. Crowe C.S. Morrison S.D. Alonso N. Calis M. Donkor P. Kreshanti P. Yuan J. Hopper R.A. Nguyen T.H. Stein C. Tovani-Palone M.R. Tran B.X. Kassebaum N.J. Abdollahi M. Alipour V. Alsharif U. Arabloo J. Bernabe E. Bolla S.R. Cho D.Y. Chung M.T. Dai X. Do H.T. Hwang B.-F. Lasrado S. Mokdad A.H. Negoi R.I. Nguyen H.L.T. Roberts N.L.S. Travillian R.S. Wilner L.B.
1 October 2021 Lippincott Williams and Wilkins

Plastic and Reconstructive Surgery
2021 #148 Issue 4 568E - 580E pp.

Background: Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease. Methods: The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed. Results: In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low-and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001). Conclusions: Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.

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Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
Division of Craniofacial and Plastic Surgery, Seattle Childrens Hospital, United States
Division of Plastic Surgery, Department of Surgery, University of São Paulo, São Paulo, Brazil
Department of Plastic, Reconstructive, and Aesthetic Surgery, Hacettepe University, Ankara, Turkey
Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Indonesia
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Division of Craniofacial and Plastic Surgery, Seattle Childrens Hospital, Seattle, WA, United States
Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, United States
Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
Department of Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
Institute for Health Metrics and Evaluation, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
Dortmund Clinic, Dortmund, Germany
Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
Department of Biomedical Sciences, Nazarbayev University, Nur-Sultan City, Kazakhstan
Department of Otolaryngology, Wayne State University, Detroit, MI, United States
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan
Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
Institute for Health Metrics and Evaluation, School of Medicine, Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States
Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam

Division of Plastic and Reconstructive Surgery
Division of Craniofacial and Plastic Surgery
Division of Plastic Surgery
Department of Plastic
Department of Surgery
Division of Plastic Reconstructive and Aesthetic Surgery
Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital
School of Medicine
Division of Craniofacial and Plastic Surgery
Section of Plastic Surgery
Center of Excellence in Behavioral Medicine
Department of Epidemiology
Department of Pathology and Legal Medicine
Department of Health Economics
Institute for Health Metrics and Evaluation
The Institute of Pharmaceutical Sciences
Health Economics Department
Dortmund Clinic
Faculty of Dentistry
Department of Biomedical Sciences
Department of Otolaryngology
Institute for Health Metrics and Evaluation
Center of Excellence in Public Health Nutrition
Department of Occupational Safety and Health
Department of Otorhinolaryngology
Institute for Health Metrics and Evaluation
Department of Anatomy and Embryology
Institute for Global Health Innovations

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