Gender inequality and burden of orofacial clefts in the Eastern Mediterranean region: findings from global burden of disease study 1990-2019

Sara Sadat Nabavizadeh; Jennifer J Mootz; Nasser Nadjmi; Benjamin B Massenburg; Kaveh Khoshnood; Ehsan Shojaeefard; Hossein Molavi Vardanjani

doi:10.1186/s12887-024-04569-6

Gender inequality and burden of orofacial clefts in the Eastern Mediterranean region: findings from global burden of disease study 1990-2019

BMC Pediatr. 2024 Jan 23;24(1):76. doi: 10.1186/s12887-024-04569-6.

Authors

Sara Sadat Nabavizadeh^{1

2}, Jennifer J Mootz^{3

4}, Nasser Nadjmi^{5

6}, Benjamin B Massenburg⁷, Kaveh Khoshnood⁸, Ehsan Shojaeefard¹, Hossein Molavi Vardanjani^{9

10}

Affiliations

¹ MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
² Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
⁴ New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA.
⁵ Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium.
⁶ Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium.
⁷ Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA.
⁸ School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
⁹ MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. hosseinmolavi@ymail.com.
¹⁰ Research Center for Traditional Medicine and History of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. hosseinmolavi@ymail.com.

Abstract

Background: Gender inequality may be associated with the burden of orofacial clefts (OFCs), particularly in low-and middle-income countries (LMICs). To investigate the OFCs' burden and its association with gender inequality in the Eastern Mediterranean region (EMR).

Methods: Country-specific data on the OFCs' prevalence and Disability-Adjusted Life Years (DALYs) from 1990 to 2019 were gathered from the Global Burden of Disease database by age and gender. Estimated annual percentage change (EAPCs) was used to investigate the OFCs' trends. The association of the Gender Inequality Index (GII) with prevalence and DALY rates was determined using multiple linear regression. Human Development Index (HDI), Socio-Demographic Index (SDI), and Gross Domestic Product (GDP) were also considered as potential confounders.

Results: In 2019, the overall regional OFCs' prevalence and DALYs (per 100,000 person-years) were 93.84 and 9.68, respectively. During the 1990-2019 period, there was a decrease in prevalence (EAPC = -0.05%), demonstrating a consistent trend across genders. Moreover, within the same timeframe, DALYs also declined (EAPC = -2.10%), with a more pronounced reduction observed among females. Gender differences were observed in age-specific prevalence rates (p-value = 0.015). GII was associated with DALYs (β_male= -0.42, p-value = 0.1; β_female = 0.48, p-value = 0.036) and prevalence (β_male= -1.86, p-value < 0.001, β_female= -2.07, p-value < 0.001).

Conclusions: Despite a declining prevalence, the burden of OFCs remained notably significant in the EMR. Gender inequality is associated with the burden of OFCs in the Eastern Mediterranean region. Countries in the region should establish comprehensive public policies to mitigate gender inequalities in healthcare services available for OFCs.

Keywords: Disability-adjusted life years; Gender inequality; Orofacial clefts; Pediatrics; Prevalence.

MeSH terms

Cleft Lip*
Cleft Palate*
Female
Gender Equity
Global Burden of Disease
Humans
Male
Mediterranean Region