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Published on: March 24, 2023
Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review
Mahmoud Omar1, Anas Qatanani2, Syed Z Kaleem2
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
Insights
Sociodemographic factors significantly impact pediatric cochlear implantation (CI) access and use globally. This review highlights disparities in CI rates and age at implantation, emphasizing the need for further research into these inequities.
Area of Science:
- Otolaryngology
- Public Health
- Health Services Research
Background:
- Pediatric cochlear implantation (CI) is a complex process revealing healthcare system weaknesses in providing timely care to deaf children.
- Understanding sociodemographic disparities is crucial for equitable access to CI services worldwide.
Purpose of the Study:
- To systematically review and identify sociodemographic factors influencing pediatric CI access and utilization.
- To determine global disparities in CI access and use among candidates and recipients.
Main Methods:
- A qualitative systematic review of major scientific databases (PubMed, Scopus, Web of Science, Embase).
- Searched for studies associating sociodemographic factors (race, income, insurance) with pediatric CI access measures (age at CI, CI rate).
- Included 39 papers from 14 countries, analyzing data from 27,751 CI-candidate children (6,623 recipients) published between 1993-2020.
Main Results:
- Measures like age at CI and CI rates are consistently reported regarding disparities.
- Access to rehabilitation, willingness for CI, and daily device use are infrequently measured.
- Persistent disparities exist in key CI access measures within certain populations, while data is scarce for others.
Conclusions:
- Sociodemographic factors demonstrably influence pediatric CI access and use.
- Significant data gaps exist for certain populations and CI access measures.
- Future research should employ multivariable analysis on representative data to clarify disparity mechanisms.
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. Laryngoscope, 132:670-686, 2022.
