Resumo Investigou-se o atraso no tratamento cirúrgico primário de fissuras labiopalatinas no âmbito do Sistema Único de Saúde (SUS) do Brasil e o efeito do contexto sociodemográfico e de indicadores socioeconômicos municipais no acesso a esse tratamento (2009-2013). Utilizaram-se informações das autorizações de internação hospitalar pagas para cirurgias primárias de lábio e de palato e variáveis socioeconômicas municipais (2010). Aplicaram-se os parâmetros adotados pela American Cleft Palate-Craniofacial Association: cirurgia de fissura de lábio (FL) aos 12 meses e de fissura de palato (FP) aos18 meses. Observou-se uma prevalência de 66,4% de atraso para cirurgias de lábio e 71,2% para cirurgias de palato, com piores percentuais nas regiões Norte (83,8% para FL e 86,6% para FP) e Nordeste (69% para FL e 75,2% para FP). Não brancos apresentaram maior prevalência de atraso nas cirurgias de fissuras de lábio, com RP = 1,40 (IC 95%: 1,30-1,50), e de fissuras palatinas, com RP = 1,27 (IC 95%: 1,21-1,33). A análise multinível identificou influência da cor autorreferida e do Índice de Desenvolvimento Humano Municipal (IDH-M) nos atrasos da queiloplastia primária e do IDH-M nos atrasos da cirurgia de palato. Ficou evidente a determinação social e o efeito de contexto no acesso a essas cirurgias no Brasil.

Abstract This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013). Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used. The ages recommended by the American Cleft Palate-Craniofacial Association (12 months for lip surgeries and 18 months for palate surgeries) were used as parameters. The prevalence of delay observed in primary lip surgeries was 66.4% and in palate surgeries was 71.2%. The North and Northeast regions had the worst percentages of delay. Non-whites had a greater prevalence of delay in cleft lip surgeries with PR = 1.40 (1.30-1.50) and cleft palate surgeries with PR = 1.27 (1.21-1.33). The multilevel analysis identified the influence of self-reported skin color and Human Development Index (HDI) on the delay of primary lip surgery, and of HDI on the delay of palate surgery. The importance of social determination on the access to primary cleft lip and palate surgeries was evident.

Resumo Investigou-se o atraso no tratamento cirúrgico primário de fissuras labiopalatinas no âmbito do Sistema Único de Saúde (SUS) do Brasil e o efeito do contexto sociodemográfico e de indicadores socioeconômicos municipais no acesso a esse tratamento (2009-2013). Utilizaram-se informações das autorizações de internação hospitalar pagas para cirurgias primárias de lábio e de palato e variáveis socioeconômicas municipais (2010). Aplicaram-se os parâmetros adotados pela American Cleft Palate-Craniofacial Association: cirurgia de fissura de lábio (FL) aos 12 meses e de fissura de palato (FP) aos18 meses. Observou-se uma prevalência de 66,4% de atraso para cirurgias de lábio e 71,2% para cirurgias de palato, com piores percentuais nas regiões Norte (83,8% para FL e 86,6% para FP) e Nordeste (69% para FL e 75,2% para FP). Não brancos apresentaram maior prevalência de atraso nas cirurgias de fissuras de lábio, com RP = 1,40 (IC 95%: 1,30-1,50), e de fissuras palatinas, com RP = 1,27 (IC 95%: 1,21-1,33). A análise multinível identificou influência da cor autorreferida e do Índice de Desenvolvimento Humano Municipal (IDH-M) nos atrasos da queiloplastia primária e do IDH-M nos atrasos da cirurgia de palato. Ficou evidente a determinação social e o efeito de contexto no acesso a essas cirurgias no Brasil.

Abstract This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013). Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used. The ages recommended by the American Cleft Palate-Craniofacial Association (12 months for lip surgeries and 18 months for palate surgeries) were used as parameters. The prevalence of delay observed in primary lip surgeries was 66.4% and in palate surgeries was 71.2%. The North and Northeast regions had the worst percentages of delay. Non-whites had a greater prevalence of delay in cleft lip surgeries with PR = 1.40 (1.30-1.50) and cleft palate surgeries with PR = 1.27 (1.21-1.33). The multilevel analysis identified the influence of self-reported skin color and Human Development Index (HDI) on the delay of primary lip surgery, and of HDI on the delay of palate surgery. The importance of social determination on the access to primary cleft lip and palate surgeries was evident.

Abstract The objective of this study was to investigate the prevalence of live births with orofacial clefts in Brazil from 2009 to 2013, according to Brazil’s federative units and regions, and correlate it with the number of corrective surgery procedures for cleft lip and palate performed through the Brazilian National Health System in the same period. The data were collected from the National Live Birth System (SINASC in Portuguese) and the Hospital Information System (SIH-SUS in Portuguese). The results showed that the average prevalence of oral clefts in the period was 5.86 per 10,000 live births, with differences observed between the federative units and the regions. The correlation between the prevalence of orofacial clefts and the number of medical procedures associated with this anomaly was statistically significant (r=0.94; p <0.001). This result indicates that greater investments are being made in areas with a higher number of cases. The relationship between supply and demand for corrective surgeries suggests that only 18.91% of the live births with orofacial clefts in this period may have received this service under the Brazilian National Health System.