The Relationship Between Orofacial Clefts and Material Deprivation

Previous studies on the association between orofacial clefts (OFCs) and socioeconomic status have produced conflicting results. Objectives: This study investigated the relationship between material deprivation and the incidence of OFCs in south Wales, U.K. Methods: The South Wales Orofacial-Cleft Register served as the primary data source for the study. Data on all children born with an OFC between 1982 and 2003 were geocoded to one of 844 geographic wards. National census data, similarly geocoded served as the population denominator. Townsend's Index of material deprivation based on: percentage unemployed; percentage of households without a car; percentage of households not owner occupied and the percentage of households overcrowded was attributed to each geographic ward. The geographic wards were then assigned to one of seven levels of deprivation. This permitted investigation of the association of OFC with material deprivation. Results: Between 1982 and 2003, 831 babies were born with an OFC, equating to 109 clefts per 100,000 live births. The incidence of OFCs ranged from 82/100,000 (95% C.I. 64-102/100,000) in babies born to mothers resident in the least deprived areas to 127/100,000 (95% C.I. 112-144/100,000) in those living in the most deprived areas, a significant linear trend being apparent (p<0.001). A statistically significant risk of 1.55 (1.18-2.04) for OFC was apparent between most and least deprived septiles of deprivation. The association was significant for the both cleft lip and palate (CL[P]) and cleft palate (CP). Conclusions: This study provides confirmatory evidence of a significant association between material deprivation and OFCs. Further work is required to elicit the degree to which potential risk factors contribute to this association.