Risk Factors Associated with Delays in Hearing Loss Identification in Pediatric Patients
Michael M Lindeborg1, Inderpreet Kaur Khalsa1, Elizabeth N Liao1
1Department of Otolaryngology, University of California, San Francisco, USA.
Insights
Sociodemographic factors like comorbidities and social vulnerability are linked to pediatric late-identified hearing loss (LIHL). Understanding these factors in LIHL subgroups can help reduce identification disparities.
Area of Science:
- Pediatric audiology
- Public health
- Health disparities
Background:
- Late-identified hearing loss (LIHL) in children presents significant challenges.
- Sociodemographic factors may influence the identification of hearing loss (HL).
- Subgroup analysis within LIHL populations is needed to understand varied risk factors.
Purpose of the Study:
- To identify sociodemographic factors associated with pediatric LIHL.
- To classify novel subgroups within the LIHL population.
- To explore variations in risk factors across different LIHL pathways.
Main Methods:
- Retrospective cohort study of 1087 children with permanent hearing loss (2012-2020).
- Comparison of early-identified HL versus LIHL (>6 months at diagnosis).
- Classification into three LIHL subgroups: late-identified congenital, late-onset, and late-identified unknown-onset HL. Geospatial analysis using ArcGIS Pro.
Main Results:
- Children with LIHL showed higher rates of comorbidities, were more likely to be from under-represented minority (URM) groups, and had higher social vulnerability index (SVI) scores.
- Late-identified unknown-onset HL was associated with non-English speaking households (AOR=1.84) and neighborhood disadvantage (AOR=4.08).
- Late-onset HL was less likely to have public insurance (AOR=0.47) and showed decreased association with neighborhood disadvantage (AOR=0.40).
Conclusions:
- Sociodemographic factors act as indicators of healthcare access and differ across LIHL pathways.
- Identifying specific risk factors for each LIHL subgroup is crucial.
- Addressing disparities in pediatric hearing loss identification requires understanding these varied sociodemographic associations.
Objective:
To identify sociodemographic factors associated with pediatric late-identified hearing loss (LIHL) and classify novel subgroups within the LIHL population.
Study Design:
Retrospective cohort.
Setting:
Tertiary children's hospital.
Methods:
Our cohort included children with permanent hearing loss (HL) between 2012 and 2020 (n = 1087). Patients with early-identified HL were compared to patients with LIHL (>6 months of age at diagnosis), and 3 subgroups: (1) late-identified congenital HL: failed NHS but had a diagnostic audiogram >6 months old; (2) late-onset HL: passed NHS and identified with HL after 6 months old; (3) late-identified, unknown-onset: unknown NHS results, identified after 6 months old. Geospatial analysis was performed using ArcGIS Pro.
Results:
Compared with early-identified children, children with LIHL were more likely to have more comorbidities (odds ratio [OR] = 1.12, [1.01, 1.23]), be an under-represented minority (URM) (OR = 1.92, [1.27, 2.93]) and have a higher social vulnerability index (SVI) (adjusted odds ratio [AOR] = 2.1, [1.14, 3.87]). However, subgroups in the LIHL cohort had variable associations. Children with late-identified unknown onset hearing loss were uniquely associated with a primarily non-English speaking household (AOR = 1.84, [1.04, 3.25]), whereas children with late-onset hearing loss were less likely to have public insurance (AOR = 0.47, [0.27, 0.81]. There were no significant associations for children with late-identified congenital hearing loss. Neighborhood disadvantage, as measured by SVI, had an increased association with late-identified unknown onset HL (AOR = 4.08, [2.01, 8.28]) and a decreased association with late-onset HL (AOR = 0.40, [0.22, 0.72]).
Conclusion:
Sociodemographic factors serve as proxies for health care access, and these factors vary across LIHL pathways. Understanding the risk factors associated with each LIHL subgroup may help address disparities in pediatric HL identification.
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