Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status

Davis, Amanda; Hicks, Kelli L.; Dillon, Margaret T.; Overton, Andrea B.; Roth, Noelle; Richter, Margaret E; Dedmon, Matthew M.

doi:10.1002/lio2.1010

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…In the US, several studies showed that non-Caucasians pursued CIs at a lower rate but qualified for CIs at higher rates (6–9,27,49). In multiple countries, socioeconomic status and education level were found to be factors in CI uptake (28,34,51,62). Eligible adults with higher incomes and higher education levels were more likely to pursue a CI.…”

Section: Resultsmentioning

confidence: 99%

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review

Neukam,

Kunnath,

Patro

et al. 2024

Preprint

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Introduction: Cochlear Implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last five years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake. Methods: Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework. Results: The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met inclusion criteria. Discussion: Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.

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Section: Resultsmentioning

confidence: 99%

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review

Neukam,

Kunnath,

Patro

et al. 2024

Preprint

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“…However, our data showed that no matter what their employment status (employed/retired/unemployed/disabled) was, it did not affect the OR of receiving the CI surgery. Davis et al (10) looked at a similar socioeconomic proxy using the zip code tabulation area-level social deprivation index. The authors noted that this correlated with whether or not they attended their CI candidacy evaluation appointment (10).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Davis et al (10) looked at a similar socioeconomic proxy using the zip code tabulation area-level social deprivation index. The authors noted that this correlated with whether or not they attended their CI candidacy evaluation appointment (10). What our study found, however, is that distance to the CI center, or living in an MUA, or their MFI did not affect whether or not they received a CI.…”

Section: Discussionmentioning

confidence: 99%

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Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

Kaul,

Dzubara,

Munjal

et al. 2023

Otol Neurotol

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Objective Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors. Study Design Retrospective cohort study. Setting Tertiary referral center. Patients Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data. Interventions Diagnostic. Main Outcome Measures Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county. Results Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11–0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009–0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94–0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12–3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A χ 2 test of independence showed no association between receiving CIs and living in medically underserved counties (χ 2 = 2; N = 493; 0.3891; p = 0.53). Conclusions Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.

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“…Nassiri et al found that among adults, there was an association between greater travel distances and older age at the time of cochlear implantation ( 13 ). Additionally, Davis et al ( 14 ) observed a significant difference in socioeconomic position (SEP) between patients who attended and did not attend the evaluation appointment for cochlear implantation. Although travel time did not differ significantly between the two groups, there was a significant interaction between SEP and geographic location in North Carolina, where rural counties were farther from the cochlear implant center and were also more likely to be associated with lower SEP.…”

Section: Introductionmentioning

confidence: 99%

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults

Fuentes-López,

Galaz-Mella,

Ayala

et al. 2024

Front. Public Health

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BackgroundAccess to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment.ObjectiveTo assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system.Methods455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects.ResultsApproximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04–1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity.ConclusionA higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

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Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status

Cited by 7 publications

References 22 publications

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review

Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults

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