Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review

Abstract

Objectives: Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country.Study Design: Systematic review. Methods: A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate.Results: Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020.Conclusion: Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data.

Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

“…Black children are less likely to receive tonsillectomy or cochlear implants, and more likely to have complications following such surgeries. 7,29,30 Our results indicate that this finding is potentially also true of surgical management of RPA. Because Black children were more likely to be antibiotic naïve upon presentation to the hospital, a possible explanation is that a trial of medical therapy was favored prior to attempting surgical management.…”

“…The finding that Black patients are less likely to receive surgical management of otolaryngologic disease has been demonstrated across numerous subspecialties of pediatric otolaryngology. Black children are less likely to receive tonsillectomy or cochlear implants, and more likely to have complications following such surgeries 7,29,30 . Our results indicate that this finding is potentially also true of surgical management of RPA.…”

Age and Incidence of Cochlear Implantation in the Pediatric Population With Congenital Bilateral Profound Hearing Loss

“…Although national trends in clinical practice typically lag behind guideline updates, the plateaued age at implantation over recent years may implicate several factors other than FDA labeling and practice guidelines that have impeded implantation in younger children. Delayed implantation in the pediatric population may result from patient or systemic factors including socioeconomic barriers, lack of access to care, issues surrounding insurance coverage and poor reimbursement, and obstacles associated with cumbersome hearing health care pathways (35)(36)(37)(38)(39)(40). In 2019, the Centers for Disease Control and Prevention estimated that over 98% of newborns were screened for hearing loss, and that almost 6,000 U.S. infants were identified with some level of permanent hearing loss (41).…”

Temporal Trends in Early Pediatric Cochlear Implantations in California from 2018 to 2020

“…Multiple previous studies have concluded that socioeconomic status-particularly race/ethnicity, insurance, and income-may have a significant impact on access to implantation, which is manifested either in the overall number of implantations or the likelihood of early implantation among these populations (9). Using the HCUP Kids' Inpatient Database, both Tampio et al (10) and Stern et al (12) found that incidence rates of pediatric implantations were decreased in Hispanic and Black children, although the former did note that rates among Hispanic children increased from 1997 to 2012.…”

“…Alongside these data showing benefit for early implantation, demand for pediatric cochlear implantation has also continued to grow. However, disparities in rates of cochlear implantation have persisted (9). Black and Hispanic children are less likely to undergo implantation than White and Asian children (10), and lower household income has been associated with later age at implantation (11).…”