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Massenburg BB, Hopper RA, Crowe CS, et al. Global Burden of Orofacial Clefts and the World Surgical Workforce. Plast Reconstr Surg. 2021;148(4):568e-580edoi: 10.1097/PRS.0000000000008334.
Massenburg, B. B., Hopper, R. A., Crowe, C. S., Morrison, S. D., Alonso, N., Calis, M., Donkor, P., Kreshanti, P., Yuan, J. (2021). Global Burden of Orofacial Clefts and the World Surgical Workforce. Plastic and reconstructive surgery, 148(4), 568e-580e. https://doi.org/10.1097/PRS.0000000000008334
Massenburg, Benjamin B, et al. "Global Burden of Orofacial Clefts and the World Surgical Workforce." Plastic and reconstructive surgery vol. 148,4 (2021): 568e-580e. doi: https://doi.org/10.1097/PRS.0000000000008334
Massenburg BB, Hopper RA, Crowe CS, Morrison SD, Alonso N, Calis M, Donkor P, Kreshanti P, Yuan J. Global Burden of Orofacial Clefts and the World Surgical Workforce. Plast Reconstr Surg. 2021 Oct 01;148(4):568e-580e. doi: 10.1097/PRS.0000000000008334. PMID: 34550940.
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Plast Reconstr Surg. 2021 Oct 01;148(4):568e-580e. doi: 10.1097/PRS.0000000000008334.

Global Burden of Orofacial Clefts and the World Surgical Workforce.

Plastic and reconstructive surgery

Benjamin B Massenburg, Richard A Hopper, Christopher S Crowe, Shane D Morrison, Nivaldo Alonso, Mert Calis, Peter Donkor, Prasetyanugraheni Kreshanti, Jie Yuan,

Affiliations

  1. From the Division of Plastic and Reconstructive Surgery, University of Washington; Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital; Division of Plastic Surgery, Department of Surgery, University of São Paulo; Department of Plastic, Reconstructive, and Aesthetic Surgery, Hacettepe University; Department of Surgery, Kwame Nkrumah University of Science and Technology; Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia; Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital; and School of Medicine, Shanghai Jiao Tong University.

PMID: 34550940 DOI: 10.1097/PRS.0000000000008334

Abstract

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.

Copyright © 2021 by the American Society of Plastic Surgeons.

References

  1. World Health Organization. Global strategies to reduce the health care burden of craniofacial anomalies: Report of WHO meetings on International Collaborative Research on Craniofacial Anomalies. Paper presented at: Report of WHO meetings on International Collaborative Research on Craniofacial Anomalies; May 24–26, 2001; Park City, Utah. - PubMed
  2. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet 2009;374:1773–1785. - PubMed
  3. Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386:569–624. - PubMed
  4. Kantar RS, Cammarata MJ, Rifkin WJ, Diaz-Siso JR, Hamdan US, Flores RL. Foundation-based cleft care in developing countries. Plast Reconstr Surg. 2019;143:1165–1178. - PubMed
  5. Ise A, Saluja S, Amundson JR, et al. Patient-perceived barriers to accessing cleft care at a tertiary referral center in São Paulo, Brazil. Cleft Palate Craniofac J. 2019;56:639–645. - PubMed
  6. Massenburg BB, Jenny HE, Saluja S, Meara JG, Shrime MG, Alonso N. Barriers to cleft lip and palate repair around the world. J Craniofac Surg. 2016;27:1741–1745. - PubMed
  7. Murray CJL, Lopez AD, Jamison DT. The global burden of disease in 1990: Summary results, sensitivity analysis and future directions. Bull World Health Organ. 1994;72:495–509. - PubMed
  8. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1789–1858. - PubMed
  9. Flaxman AD, Vos T, Murray CJL, eds. An Integrative Metaregression Framework for Descriptive Epidemiology. Seattle: University of Washington Press; 2015. - PubMed
  10. Kyu HH, Abate D, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1859–1922. - PubMed
  11. Dicker D, Nguyen G, Abate D, et al. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1684–1735. - PubMed
  12. Institute for Health Metrics and Evaluation. Findings from the Global Burden of Disease Study 2017. Available at: http://www.healthdata.org/sites/default/files/files/policy_report/2019/GBD_2017_Booklet.pdf. Accessed April 21, 2020. - PubMed
  13. The World Bank. GNI per capita, Atlas method (current US$). Available at: https://data.worldbank.org/indicator/NY.GNP.PCAP.CD. Accessed April 21, 2020. - PubMed
  14. The World Bank. >Specialist surgical workforce (per 100,000 population)—United States. Available at: https://data.worldbank.org/indicator/SH.MED.SAOP.P5?locations=US. Accessed September 9, 2019. - PubMed
  15. Kadir A, Mossey PA, Blencowe H, et al. Systematic review and meta-analysis of the birth prevalence of orofacial clefts in low- and middle-income countries. Cleft Palate Craniofac J. 2017;54:571–581. - PubMed
  16. Butali A, Adeyemo WL, Mossey PA, et al. Prevalence of orofacial clefts in Nigeria. Cleft Palate Craniofac J. 2014;51:320–325. - PubMed
  17. Eshete M, Butali A, Deressa W, et al. Descriptive epidemiology of orofacial clefts in Ethiopia. J Craniofac Surg. 2017;28:334–337. - PubMed
  18. Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg. 2012;129:511e–518e. - PubMed
  19. Elahi MM, Jackson IT, Elahi O, et al. Epidemiology of cleft lip and cleft palate in Pakistan. Plast Reconstr Surg. 2004;113:1548–1555. - PubMed
  20. Murray JC, Daack-Hirsch S, Buetow KH, et al. Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Cleft Palate Craniofac J. 1997;34:7–10. - PubMed
  21. Panamonta V, Pradubwong S, Panamonta M, Chowchuen B. Global birth prevalence of orofacial clefts: A systematic review. J Med Assoc Thai. 2015;98(Suppl 7):S11–S21. - PubMed
  22. Berg E, Haaland ØA, Feragen KB, et al. Health status among adults born with an oral cleft in Norway. JAMA Pediatr. 2016;170:1063–1070. - PubMed
  23. Asante AD, Negin J, Hall J, Dewdney J, Zwi AB. Analysis of policy implications and challenges of the Cuban health assistance program related to human resources for health in the Pacific. Hum Resour Health 2012;10:10. - PubMed
  24. GBD 2016 Healthcare Access and Quality Collaborators. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018;391:2236–2271. - PubMed
  25. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Cleft Palate Craniofac J. 2018;55:137–156. - PubMed
  26. Massenburg BB, Saluja S, Jenny HE, et al. Assessing the Brazilian surgical system with six surgical indicators: A descriptive and modelling study. BMJ Glob Health 2017;2:e000226. - PubMed
  27. Wu RT, Shultz BN, Peck CJ, Smetona JT, Steinbacher DM. Hospital volume improves primary, revision, and delayed cleft palate repair. J Craniofac Surg. 2019;30:1201–1205. - PubMed
  28. Shaw WC, Dahl E, Asher-McDade C, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions. Cleft Palate Craniofac J. 1992;29:413–418. - PubMed
  29. Hughes CD, Alkire B, Martin C, Semer N, Meara JG. American plastic surgery and global health: A brief history. Ann Plast Surg. 2012;68:222–225. - PubMed
  30. Shrime MG, Sleemi A, Ravilla TD. Charitable platforms in global surgery: A systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg. 2015;39:10–20. - PubMed
  31. Schneider WJ, Politis GD, Gosain AK, et al. Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world. Plast Reconstr Surg. 2011;127:2477–2486. - PubMed
  32. Saluja S, Rudolfson N, Massenburg BB, Meara JG, Shrime MG. The impact of physician migration on mortality in low and middle-income countries: An economic modelling study. BMJ Glob Health 2020;5:e001535. - PubMed
  33. Patel PB, Hoyler M, Maine R, Hughes CD, Hagander L, Meara JG. An opportunity for diagonal development in global surgery: Cleft lip and palate care in resource-limited settings. Plast Surg Int. 2012;2012:892437. - PubMed

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