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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.
Insights
Racial and insurance disparities significantly impact early cochlear implantation access for children. Black and Hispanic children, and those with Medicaid, face delays, highlighting critical inequalities in pediatric care.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Health Equity
Background:
- Early cochlear implantation is crucial for pediatric hearing rehabilitation.
- Existing research suggests potential disparities in access to medical interventions based on race and socioeconomic factors.
Purpose of the Study:
- To investigate the association between race/ethnicity and insurance status with timely access to cochlear implantation in children.
- To identify specific demographic groups experiencing delays in early cochlear implantation.
Main Methods:
- A population-based retrospective analysis was conducted using Florida's Ambulatory Surgery and Services Databases (2005-2017).
- Pediatric patients (≤18 years) undergoing cochlear implantation were identified, with a focus on implantation before 1 and 2 years of age.
- Descriptive statistics and multivariate logistic regression analyses were employed to assess disparities.
Main Results:
- Of 1511 pediatric cochlear implantations, only 4.3% occurred before age 1 and 23.0% before age 2.
- Black and Hispanic children, as well as those with Medicaid, were significantly less likely to receive cochlear implantation before age 2.
- Disparities persisted even among privately insured Black and Hispanic children compared to white children.
Conclusions:
- Significant racial/ethnic and insurance-based disparities exist in accessing early pediatric cochlear implantation.
- Addressing these inequalities requires a multidisciplinary approach, including targeted research and policy interventions.
- Population-level data reveal disparities that necessitate focused efforts to ensure equitable access to hearing restoration.
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.
