Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program

Sims, Sheree; Houston, Lisa; Schweinzger, Ivy; Samy, Ravi N.

doi:10.1097/moo.0000000000000399

Cited by 19 publications

(28 citation statements)

References 4 publications

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“…15 While 1 might think poor HA utilization translates to poor CI utilization, CI are covered by insurance if the hearing is poor enough. Exploring the low CI uptake in the Cincinnati African American community, Sims et al 16 noted that physician mistrust, access to care issues, and lack of awareness of hearing healthcare options contributed to the low uptake in their program. Nonetheless, we believe the differences we found are not the result of differences in hearing, but the result of health disparities between races.…”

Section: Discussionmentioning

confidence: 99%

“…Why aren’t the CI per capita rates equal between races? As Sims et al 16 stressed, improving access to care and CI awareness can help, addressing physician mistrust is an additional issue that is conceivably the common thread. We believe this data demonstrates that CI awareness is improving, while also suggesting that CI centers should target populations in their community to selectively reach historically marginalized groups.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Cochlear Implantation in Texas: An Exploration of Outpatient Discharge Data, 2010 to 2017

Balachandra

Xierali

Nivet

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: To describe trends in cochlear implantation (CI) disparities in Texas using an all-payer database from 2010 to 2017. Methods: Texas Outpatient Surgical and Radiological Procedure Data, a public use data file, was accessed to analyze outpatient CI cases for Texas. Variables analyzed include patient age, sex, race/ethnicity, and insurance status. Population data from the American Community Survey generated CI utilization rates by patient demographic characteristics. Results: There were 6158 CI cases identified during the study period. The number of CI per year nearly doubled from 497 in 2010 to 961 in 2017. The majority of CI recipients were white (59.5%), male (51.9%), and privately insured (47.9%). All sub-populations statewide had more CI in 2017 compared to 2010, with the overall CI per 100 000 population increasing from 1.98 to 3.50 per 100 000 population. Patients over 75 demonstrated the greatest increase in the CI rate per 100 000 population, increasing from 4.60 in 2010 to 14.30 in 2017. Regarding race/ethnicity, all sub-populations noted an increase in the CI per 100 000 population, with white patients demonstrating the highest rate in 2017, at 4.36 CI per 100 000 population. Asian patients had a 502% increase in the CI rate (from 0.42 to 2.53), compared with 87.9%, 84.4%, and 69.2% increases for white, Black, and Hispanic populations, respectively. Conclusions: CI became more widespread between 2010 and 2017, benefiting certain populations more than others. Black and Hispanic populations had lower CI per 100 000 population than their white peers, while patients >65 years of age accounted for the greatest increase in CI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Cochlear Implantation in Texas: An Exploration of Outpatient Discharge Data, 2010 to 2017

Balachandra

Xierali

Nivet

et al. 2021

Ann Otol Rhinol Laryngol

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“…This physical neighborhood disconnect with cochlear implant centers is difficult to overcome, but opportunities are present to proactively engage key stakeholders and community members to be a part of making meaningful linkages with hearing healthcare teams. 59…”

Section: Neighborhood and Physical Environmentmentioning

confidence: 99%

Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Schuh

Bush

2021

Semin Hear

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Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants.

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“…[5][6][7] Lack of awareness among primary care physicians, insufficient screening, limited patient understanding, financial constraints, and distance to CI centers have previously been cited as possible explanations for low referral and implantation rates. [5][6][7][8][9][10][11] Patient demographics, however, may also play a significant role in the relatively low CI utilization rates in adults. [8][9][10][11][12][13] Until recently, the vast majority of the published literature on racial and socioeconomic disparities in cochlear implantation has focused on the pediatric population.…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11] Patient demographics, however, may also play a significant role in the relatively low CI utilization rates in adults. [8][9][10][11][12][13] Until recently, the vast majority of the published literature on racial and socioeconomic disparities in cochlear implantation has focused on the pediatric population. [14][15][16][17][18][19] White and Asian children have been shown to undergo cochlear implantation at higher rates than their Black and Hispanic counterparts.…”

mentioning

confidence: 99%

Racial Disparities in Adult Cochlear Implantation

Mahendran

Rosenbluth

Featherstone

et al. 2021

Otolaryngol.--head neck surg.

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Objective To compare rates of cochlear implant referral and cochlear implantation across different races and to compare audiometric profiles of these patients. Study Design Retrospective study. Setting Academic tertiary care institution. Methods Demographic and audiometric data were collected for patients who underwent cochlear implant evaluation or cochlear implantation from 2010 to 2020. Results A total of 504 patients underwent cochlear implant evaluation; 388 met cochlear implant candidacy criteria, and 258 underwent implantation. Of the patients referred for cochlear implant evaluation, 68.5% were White, 18.5% were Black, and 12.3% were Asian, while the institution’s primary service area is 46.9% White, 42.3% Black, and 7.7% Asian (P < .001). Black patients referred for cochlear implant evaluation had significantly worse hearing (mean pure-tone average [PTA] 84.5 dB, 26.1% word recognition) than White patients (mean PTA 78.2 dB, P = .005; 35.7% word recognition, P = .015) and Asians patients (mean PTA 77.9 dB, P = .04; 36.5% word recognition, P = .04). Black patients who underwent cochlear implant evaluation also had significantly worse AzBio scores than White patients: 24.5% versus 36.7% (P = .003). There was no significant difference in cochlear implantation rates between Black and White candidates (P = .06). Conclusion Black patients undergo cochlear implant evaluation and cochlear implantation at rates disproportionately lower than expected based on local demographics. In addition, Black patients have significantly worse hearing at the time of cochlear implant referral than White and Asian patients. Identifying and increasing awareness of these disparities are essential steps to improving cochlear implant access for potentially disadvantaged populations.

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Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program

Cited by 19 publications

References 4 publications

Trends in Cochlear Implantation in Texas: An Exploration of Outpatient Discharge Data, 2010 to 2017

Trends in Cochlear Implantation in Texas: An Exploration of Outpatient Discharge Data, 2010 to 2017

Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Racial Disparities in Adult Cochlear Implantation

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