Assessment of appalachian region pediatric hearing healthcare disparities and delays

Abstract

Objective The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity. Study design Retrospective analysis Methods Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed. Results 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (p=0.006), amplification (p=0.030), and cochlear implantation (p=0.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (p=0.028), amplification (0.087) and cochlear implantation (p<0.0001). Conclusions Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care.

Rural Family Perspectives and Experiences with Early Infant Hearing Detection and Intervention: A Qualitative Study

“…This difficulty is greatly exaggerated in an extremely rural setting with few providers and scarce resources, such as the Appalachian region of Kentucky. Infants from rural communities, such as Appalachia, are at a significant risk of being delayed in diagnosis and treatment of congenital hearing loss [3, 4, 8, 11]. Low socioeconomic status, low education level of parents, public health insurance coverage, and extreme rural residence all contribute to delays in hearing healthcare [3].…”

Disparities in access to pediatric hearing health care

“…and treatment of hearing loss. 20–22 Even more concerning, there evidence that more children with severe hearing loss reside in rural areas. 11 Rural Hispanic children with low caregiver English fluency are also reported to have poor utilization of healthcare services.…”

“…30 Children from rural areas with congenital hearing loss are significantly delayed in receipt of hearing aids and cochlear implants, with many rural children being twice as old as their urban counterparts when they receive these devices. 22 There is compelling evidence that suggests that with each year after birth that cochlear implantation in children is delayed there is a substantially greater financial burden for the family, educational system, and the healthcare system. 31 Children with cochlear implants rom healthcare inequity settings with public insurance also tend to have poorer sound recognition outcomes when controlling for other variables such as age of the child, timing of implantation, and frequency of speech rehabilitation services.…”

Pediatric Hearing Healthcare in Kentucky’s Appalachian Primary Care Setting

“…12,15,20 This is a multifactorial problem that must be managed on multiple levels. Management of congenital hearing loss requires a multidisciplinary approach can be complex, even when an abundance of specialists are present.…”

“…Children who are deaf or hard of hearing from Appalachia are alarmingly delayed in diagnosis and treatment of hearing loss. 12,15 Appalachia is a 205,000 square mile region that spans 13 states and is home to more than 25 million people. 16 This vast region largely faces extreme community health disparities.…”