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Updated: Dec 9, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation
Xinliang Liu1, Linda I Rosa-Lugo2, Janel L Cosby2
1Department of Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, Florida, USA.
Objective:
To evaluate the association between race/ethnicity and insurance status on the access to early cochlear implantation.
Study Design:
Population-based retrospective analysis of pediatric cochlear implantation procedures.
Setting:
State Ambulatory Surgery and Services Databases of Florida from 2005 to 2017.
Methods:
All children aged 18 years or younger in the state of Florida undergoing cochlear implantation were identified. The outcome measures were access to early cochlear implantation (before 1 and 2 years of age). Descriptive and multivariate logistic regression analyses were conducted.
Results:
Among 1511 pediatric cochlear implantation procedures with complete data, 65 (4.3%) procedures were performed by 1 year of age and 348 (23.0%) by 2 years of age. Black children (odds ratio [OR], 0.44; 95% CI, 0.28-0.70), Hispanic children (OR, 0.70; 95% CI, 0.52-0.94), and children with Medicaid (OR, 0.64; 95% CI, 0.48-0.84) were significantly less likely to be implanted before 2 years of age. Even when insured by private insurance, black and Hispanic children were still less likely to be implanted before 2 years of age compared to white children with private insurance. Greater racial and insurance disparities existed in access to cochlear implantation before 1 year of age compared to implantation before 2 years of age.
Conclusion:
Racial/ethnic and insurance disparities in pediatric cochlear implantation can be observed at the population level. To address these racial and insurance inequalities, a multidisciplinary care team is needed and priorities should be given to research endeavors and policy interventions that target these disparities.
