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Updated: Jul 13, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Temporal Trends in Early Pediatric Cochlear Implantations in California from 2018 to 2020
Rance J T Fujiwara1, Emily C Wong1, Gail Ishiyama2
1Department of Head and Neck Surgery.
Insights
Socioeconomic factors, particularly public insurance, impact early cochlear implantation in children. Disparities in pediatric cochlear implantation access improved significantly in California between 2018 and 2020.
Area of Science:
- Pediatric audiology
- Health services research
- Medical device technology
Background:
- Cochlear implantation is crucial for hearing restoration in children.
- Understanding demographic factors influencing timely implantation is essential for equitable access.
- Previous research indicates disparities in healthcare access based on socioeconomic status.
Purpose of the Study:
- To analyze the demographics of children undergoing cochlear implantation.
- To identify factors associated with delayed cochlear implantation in pediatric patients.
- To track trends in these factors over time.
Main Methods:
- Retrospective cross-sectional study using the Healthcare Cost and Utilization Project California State Ambulatory Surgery Database (2018-2020).
- Analysis of 467 children aged 5 years or younger who received cochlear implants.
- Mixed-effects logistic regression to determine factors associated with early implantation (≤2 years) and their temporal changes.
Main Results:
- Cochlear implantations increased by 24.1% from 2018 to 2020.
- Medicaid insurance was significantly associated with decreased odds of early implantation (OR, 0.18).
- The proportion of children with Medicaid receiving early implantation rose from 20.9% to 62.0% during the study period.
Conclusions:
- Socioeconomic factors, especially public insurance, correlate with cochlear implantation age in California children.
- Significant improvements in these disparities were observed from 2018 to 2020.
- California's initiatives may offer insights for national strategies to enhance pediatric cochlear implantation access.
Objective:
To characterize the demographics of children receiving cochlear implantations, identify factors associated with delayed implantations, and trend these factors over time.
Design:
Retrospective cross-sectional study.
Setting:
Healthcare Cost and Utilization Project California State Ambulatory Surgery Database for calendar years 2018-2020.
Patients:
Children 5 years or younger undergoing cochlear implantation.
Interventions:
Cochlear implantation.
Main Outcomes Measures:
The population-controlled number of cochlear implantations was calculated and stratified by race and insurance. Early implantation was defined as implantation at age 2 years or younger. A mixed-effects logistic regression model was generated to identify factors associated with early implantation and how that association changed from 2018 to 2020.
Results:
The final cohort included 467 children. The number of implantations increased from 141 to 175 implants from 2018 to 2020 (24.1% increase); 229 (49.0%) children were implanted at 2 years or younger. Medicaid insurance was associated with decreased odds of early implantation (odds ratio, 0.18 [95% confidence interval, 0.15-0.23], p < 0.001); this association with Medicaid insurance was significant when stratified across all racial groups. The percentage of children with Medicaid who were implanted at 2 years or younger increased from 20.9 to 62.0% from 2018 to 2020.
Conclusions And Relevance:
Among children in California, socioeconomic factors, in particular public insurance, are correlated with age of cochlear implantation. These disparities improved significantly from 2018 to 2020. Further investigation into changes and initiatives in California during this time frame may aid in directing national efforts to improve pediatric cochlear implantation access.
