Distance and Socieoeconomic Status as Barriers to Cochlear Implantation

Cheung, Linnea L; Fowler, Alexander J.; Hassarati, Rachelle T; Birman, Catherine S.

doi:10.1097/mao.0000000000003765

Cited by 5 publications

(12 citation statements)

References 18 publications

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“…Similar findings have been observed in studies conducted worldwide. In Australia, recipients were more likely to live in the least 2 deprived deciles [ 7 ]. Similarly, in the US, adults with private insurance were 13 times more likely to receive cochlear implants compared to those under Medicare cover [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…This study indicated that adults who had their referral candidacy confirmed with audiometric assessment at an implant centre were more likely to be referred, possibly due to geographical proximity between the patient’s home and the implant centre, but also possibly due to a greater intra-departmental appreciation of cochlear implantation as an option for these patients, and reduced administrative burden in referring these patients to colleagues in the same centre. In Australia, the majority of adult recipients lived near major urban centres [ 7 ]. Among American veterans, rural adults waited longer to obtain both hearing aids and implants, due to longer commutes and lower incomes [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The implantation rate is thought to be as low as 5% to 10% of those potentially eligible [ 6 ], although there has been no recent assessment of this across the UK. Although disparities have been documented in hearing healthcare and implant uptake, the majority of studies evaluating access to implants focus on what happens once patients are assessed at implant centres, rather than the stages leading up to and including referral for assessment [ 7 , 8 ]. Analysing patterns at these gateway stages in a patient’s cochlear implant journey, may lead to a deeper understanding of the referral pathway, enabling identification of the main drivers of inequalities in care, as well as the impact of key healthcare disparities, such as ethnicity and socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Swords,

Ghedia,

Blanchford

et al. 2024

PLoS Med

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Background Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Swords,

Ghedia,

Blanchford

et al. 2024

PLoS Med

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“…Therefore, identifying patient‐specific factors predicting the pursuit of CI surgery is important in determining ways to improve uptake. Previous studies have found longer distances from CI centers, older patient age, racial minorities, and unmarried status negatively affect the likelihood of undergoing implantation 7,16,17 . This study therefore sought to validate and investigate other socioeconomic and patient‐related factors, such as income and employment status, that may impact patients' decision‐making in undergoing CI surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have found longer distances from CI centers, older patient age, racial minorities, and unmarried status negatively affect the likelihood of undergoing implantation. 7,16,17 This study therefore sought to validate and investigate other socioeconomic and patient-related factors, such as income and employment status, that may impact patients' decision-making in undergoing CI surgery. In addition, given the higher need for implantation in the elderly population, these factors were reanalyzed in a subset of patients aged 65 years and older to identify changes in the predictor profile.…”

Section: Introductionmentioning

confidence: 99%

Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case–Control Study

Kato,

Kaul,

Hallak

et al. 2023

The Laryngoscope

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Objective(s)Despite undergoing thorough cochlear implant (CI) candidacy evaluation and counseling, some patients ultimately elect against implantation. This study sought to identify patient‐related and socioeconomic factors predicting CI deferral.MethodsA retrospective study of adult (≥18 years old) CI candidates presenting between 2007 and 2021 at a tertiary academic CI center was performed. The primary outcome was device implantation. Data collected included age, gender, hearing status, race, zip code of residence, median family income (MFI), distance traveled from the CI center, marital status, employment status, and insurance status. Multivariable binary logistic regression was performed to identify predictors of implantation.ResultsA total of 200 patients qualifying for CI were included, encompassing 77 adults deferring surgery (CI‐deferred) and 123 consecutive adults electing for surgery (CI‐pursued). Age, gender, hearing status, insurance type, employment status, distance from the implant center, and MFI were comparable between the groups (p > 0.05). Compared to CI‐pursued patients, CI‐deferred patients were more likely to be non‐Caucasian (24.7% vs. 9.8%, p = 0.015) and unmarried (55.8% vs. 38.2%, p = 0.015). On multivariable logistic regression, older age (OR 0.981, 0.964–0.998, p = 0.027), African American race (OR 0.227, 0.071–0.726, p = 0.012), and unmarried status (OR 0.505, 0.273–0.935, p = 0.030) were independent predictors of implant deferral.ConclusionThis study demonstrates that increasing age at evaluation, African American race, and unmarried status are predictors for deferring CI surgery despite being implant candidates. These patients may benefit from increased outreach in the form of counseling, education, and social support prior to undergoing CI surgery.Level of Evidence3 – retrospective study with internal control group Laryngoscope, 2023

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A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss

Hall,

Dillon,

Pryce

et al. 2024

International Journal of Audiology

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Distance and Socieoeconomic Status as Barriers to Cochlear Implantation

Cited by 5 publications

References 18 publications

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case–Control Study

A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss

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