Mapping Disparities In Access To Cleft And Craniofacial Care For American Indian And Alaska Native Populations

Purpose: American Indian and Alaska Native (AI/AN) children are disproportionately affected by orofacial clefts, yet access to comprehensive cleft and craniofacial care has not been systematically quantified. National disparities in provider distribution, geographic accessibility, and multidisciplinary team composition may exacerbate delays in treatment and worsen long-term functional outcomes. This study used geospatial mapping to evaluate the availability of cleft care resources across states with high versus low AI/AN populations. Methods: Data on cleft care centers and workforce composition were obtained through public ACPA (American Cleft Palate-Craniofacial Association) center listings and cross-verified with professional society directories. States with the highest AI/AN population densities (Alaska, Oklahoma, New Mexico, South Dakota, Montana, North Dakota, and Arizona) were compared to states with the lowest AI/AN populations (Kentucky, Florida, West Virginia, Ohio, New Hampshire, Massachusetts, and Pennsylvania). Provider counts across surgical and allied health specialties were tabulated, and average travel distance and time to the nearest craniofacial surgeon were calculated. Statistical comparisons between groups were performed using Student's t-tests. Results: Significant disparities were observed between high-AI/AN and low-AI/AN states. In high-AI/AN states, the mean number of cleft centers was 0.86 compared with 4.43 in low-AI/AN states (p = 0.019). Plastic surgery availability was similarly reduced, averaging only 1 surgeon per high-AI/AN state compared with 8.86 in low-AI/AN states (p = 0.015). Orthodontists and speech-language pathologists—essential members of multidisciplinary teams—were also significantly underrepresented, with averages of 1.57 and 2.29 in high-AI/AN states versus 8.86 and 11.57 in low-AI/AN states, respectively (p = 0.030 and p = 0.029). OMFS support was nearly absent in AI/AN-dense regions (0.86 vs. 4.14, p = 0.008). Geographic isolation further compounded these workforce gaps. Families in high-AI/AN states traveled an average of 556 miles (861 minutes) to reach a craniofacial surgeon, compared with 86 miles (104 minutes) in low-AI/AN states (p = 0.036). Although neurosurgery and ENT coverage did not differ significantly, the relative absence of cleft-specialized teams in AI/AN-dense states highlights persistent inequities in access to multidisciplinary care. Conclusions: This geospatial analysis demonstrates that AI/AN populations face profound shortages in cleft care resources, with significantly fewer accredited centers, surgical specialists, and allied health providers, coupled with far greater travel burdens. These findings underscore the inadequacy of relying solely on national accreditation metrics, as per capita access remains severely limited for Indigenous populations. Addressing these disparities requires workforce redistribution, expansion of cleft-trained providers in high-need regions, and AI/AN-led strategies to ensure culturally responsive, geographically accessible care. *Source: https://ps-rc.org/meeting/Program/2026/OS65.cgi*