Results indicate that an additional $4.6 billion will be spent over the lifetime of persons who acquired their impairment in 1998. The particularly high costs associated with prelingual onset of severe to profound hearing impairment suggest interventions aimed at children, such as early identification and/or aggressive medical intervention, may have a substantial payback.

ABSTRACT.Objective. This study examined the factors that affect children's receipt of recommended wellchild and dental visits using nationally representative data.Methods. We analyzed the Child Public Use File of the 1999 National Survey of America's Families, including 35 938 children who were younger than 18 years. Bivariate and multivariate analyses were conducted to examine the relationship between dependent variables, including receipt of well-child visits as recommended by the American Academy of Pediatrics' periodicity schedule and dental visits as recommended by the American Academy of Pediatric Dentistry and Bright Futures, and independent variables, including health status and sociodemographic and economic indicators.Results. Overall, 23.4% of children did not receive the recommended well-child visits, whereas 46.8% did not receive the recommended number of dental visits. The factors that predict nonreceipt of care differed for wellchild and dental care and with child's age. Logistic regression reveals that children who were young (<10 years old), uninsured, non-Hispanic white, had a parent who was less than college educated, or in poor health were least likely to meet the recommendations for wellchild care. Children who did not meet the dental recommendation were more likely to be black, uninsured, from families with low incomes, have a parent who was less than college educated, and have postponed dental care in the last year. These risk factors increased with children's age.Conclusions. A substantial proportion of US children do not receive preventive care according to professionally recommended standards, particularly dental care. Publicly insured children experience higher rates of recommended well-child visits; however, much improvement is needed among public programs in providing recommended dental care, especially among adolescents and children in poor general health. Pediatrics 2002;110(6). URL: http://www.pediatrics.org/cgi/content/ full/110/6/e73; child, dental health services, multivariate analysis, preventive health services, professional organizations.

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This study informs policy makers and third-party payers of the prevalence and characteristics of the severely to profoundly hearing-impaired population in the United States. Nationally representative data were used for estimations in consultation with an expert advisory panel. The prevalence of severe to profound hearing impairment among the US population ranges from 464,000 to 738,000, with 54 percent of this population over age 65 years. Persons with hearing impairment are more likely to be publicly insured, less likely to have private insurance, have lower family incomes, are less educated, and are more likely to be unemployed than the general population. Approximately half a million Americans are severely to profoundly hearing impaired and appear to be more vulnerable, both financially and educationally, as compared to the US population. As a result, access to medical and technological interventions that may assist their hearing loss may be limited. Abbreviations: NHANES = National Health and Nutrition Examination Survey, NHIS = National Health Interview Survey