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Exploring Factors Responsible for Delay in Pediatric Cochlear Implantation
Jacquelyn DeVries1, Yin Ren1, Julie Purdy2
1Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California.
Insights
Children with public insurance or from low-income areas experience significant delays in cochlear implantation (CI). These delays impact crucial pre-implantation evaluations and overall access to care for pediatric hearing loss.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Medical Audiology
Background:
- Cochlear implantation (CI) is a critical intervention for pediatric hearing loss.
- Timely access to CI is essential for optimal speech and language development.
- Socioeconomic and demographic factors may influence CI access and timing.
Purpose of the Study:
- To identify and characterize demographic and socioeconomic factors associated with delays in pediatric cochlear implantation (CI).
- To analyze the impact of insurance status and income on the timeliness of CI.
- To investigate delays in pre-CI evaluations based on patient characteristics.
Main Methods:
- Retrospective study of pediatric patients receiving CI between March 2018 and February 2020 at a tertiary referral center.
- Analysis of demographic data, insurance status, income level, and time from diagnosis/candidacy to implantation.
- Comparison of pre-CI workup durations (vestibular, developmental, speech, ChIP assessments) between patient groups.
Main Results:
- Patients with public insurance and those from low-income areas experienced significantly older ages at implantation and longer delays from diagnosis to CI.
- Publicly insured patients faced extended waiting times for candidacy evaluation to implantation and pre-CI assessments.
- Latinx children were more frequently publicly insured, while white children were more often privately insured, highlighting ethnic disparities in access.
Conclusions:
- Significant disparities in access to CI persist, disproportionately affecting publicly insured and low-income children.
- Delays in pre-CI evaluations, including vestibular and developmental assessments, are more pronounced in publicly insured populations.
- These findings underscore the need for interventions to mitigate socioeconomic barriers and ensure equitable access to timely cochlear implantation for all children.
Objective:
To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children.
Study Design:
Retrospective.
Setting:
Tertiary pediatric CI referral center.
Patients:
All patients under 18 years of age receiving CI between March 2018 and February 2020.
Interventions:
CI.
Main Outcome Measures:
Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI.
Results:
Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 ± 0.8 yr versus 3.1 ± 0.7 yr, p = 0.007) and those from low-income areas (8.6 ± 7.6 yr versus 2.4 ± 3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 ± 0.6 yr versus 2.2 ± 0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 ± 107d versus 291 ± 64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 ± 0.2 versus 1.0 ± 0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 ± 132 d versus 197 ± 67 d, p = 0.007), developmental evaluation (517 ± 106 d versus 150 ± 56 d, p = 0.003), speech evaluation (482 ± 107 d versus 163 ± 65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 ± 107d versus 184 ± 59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 × 10-4) and children with public insurance (p = 0.016; p = 0.002).
Conclusions:
Disparities in access to CI continue to affect timing of pediatric cochlear implantation.
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