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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Pediatric cochlear implantation: Variation in income, race, payer, and charges across five states
Zhen Huang1, Heather Gordish-Dressman2, Diego Preciado2
1Department of Otorhinolaryngology, University of Texas-Health Science Center at Houston, Houston, Texas.
Insights
Pediatric cochlear implantation (PCI) age was similar across states, but significant geographic variations exist in charges, insurance, race, and income. Further analysis is needed to address these healthcare disparities.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Health Economics
Background:
- Pediatric cochlear implantation (PCI) is a critical intervention for hearing loss.
- Understanding geographical variations in PCI is essential for equitable healthcare delivery.
- Previous studies have not comprehensively analyzed state-level disparities in PCI demographics and costs.
Purpose of the Study:
- To investigate pediatric cochlear implantation (PCI) across representative US states.
- To analyze geographical differences in patient age, median household income, race, insurance, and total medical charges.
- To identify potential disparities in PCI access and outcomes.
Main Methods:
- Cross-sectional study utilizing 2011 State Ambulatory Surgery and Services Databases from CA, FL, MD, NY, and KY.
- Analysis included 512 pediatric cochlear implantation cases (ages 0.5-18 years).
- Statistical methods included Kruskal-Wallis, Wilcoxon rank sum tests, and nominal logistic regression.
Main Results:
- No significant difference in the age of pediatric cochlear implantation (PCI) across the five states.
- Significant geographical variations were observed in primary payer (P < .001), median household income quartiles (P < .006), race (P < .001), and total median hospital charges (P < .001).
- California (CA) was an exception in terms of total median hospital charges.
Conclusions:
- While the age of pediatric cochlear implantation (PCI) is consistent across states, significant geographic disparities exist in associated costs, insurance, patient race, and socioeconomic status.
- These findings highlight the need for further investigation into the root causes of these disparities.
- Addressing these variations is crucial for improving healthcare delivery and establishing uniform standards of care for PCI.
Objectives/Hypothesis:
Our objectives were to investigate pediatric cochlear implantation (PCI) across representative states within the United States and analyze any geographical differences in age, median household income, race, insurance, and total medical charges.
Study Design:
Cross-sectional.
Methods:
Data from children (aged 0.5-18 years) who received cochlear implantation surgery were collected from the 2011 State Ambulatory Surgery and Services Databases from California (CA), Florida (FL), Maryland (MD), New York (NY), and Kentucky (KY) as a part of the Healthcare Cost and Utilization Project. We performed data analysis using a combination of Kruskal-Wallis and Wilcoxon rank sum tests, as well as nominal logistic regression.
Results:
Five hundred twelve cases of PCI were performed during 2011 across the five states. The overall mean and median age of implantation were 5.6 years and 4 years, respectively. There was no statistical difference in age of implantation across states (P = .85). However, there were statistical differences in primary payer (P < .001), median household income quartiles of patients who received an implant (P < .006), race (P < .001), and total median hospital charges for four of the states, with the exception of CA (P < .001).
Conclusions:
Age of PCI appears to be similar across the five states in cross-sectional analysis. Geographic variations in charges, payer, race, and median household income occur with statistical significance in PCI. Further analysis of contributing factors at each state level may help elucidate the root cause of these disparities and improve and justify a uniform approach to healthcare delivery and standards of care.
Level Of Evidence:
4. Laryngoscope, 128:954-958, 2018.
