Barriers to Meeting National Early Hearing Detection and Intervention Guidelines in a Diverse Patient Cohort
Katrin Jaradeh1, Elizabeth N Liao2, Michael Lindeborg3
1Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
Insights
Delays in identifying and intervening for congenital sensorineural hearing loss in children are linked to Hispanic ethnicity and the number of auditory brainstem response (ABR) tests. Addressing these factors can improve early intervention outcomes.
Area of Science:
- Pediatric audiology
- Public health
- Health disparities
Background:
- Congenital sensorineural hearing loss requires timely identification and intervention.
- The Joint Committee on Infant Hearing established 1-3-6 benchmarks for early audiology care.
- Factors contributing to delays in diagnosis and treatment need further investigation.
Purpose of the Study:
- To assess audiology clinic performance against the 1-3-6 benchmarks for congenital sensorineural hearing loss.
- To identify demographic, social, and health factors associated with delayed identification and intervention.
- To explore potential mediators influencing these delays.
Main Methods:
- Retrospective case series of 132 children with sensorineural hearing loss (2018-2021).
- Analysis of auditory brainstem response (ABR) testing, hearing aid evaluation, and cochlear implant mapping data.
- Linear regression and mediator analyses to identify factors associated with age at identification and intervention.
Main Results:
- Hispanic ethnicity and public insurance were associated with delayed identification and intervention.
- A higher total number of ABRs correlated with older ages at identification and intervention.
- Mediator analysis indicated that the number of ABRs influences the impact of ethnicity on identification age.
Conclusions:
- The total number of ABRs is significantly associated with delayed identification and intervention for pediatric hearing loss.
- Hispanic ethnicity contributes to delays, with the number of ABRs acting as a mediating factor.
- Targeting ABR processes may help reduce ethnic disparities in early hearing loss intervention.
Objectives:
To determine our audiology clinics status in meeting the Joint Committee on Infant Hearing recommended 1-3-6 benchmarks for identification and intervention for congenital sensorineural hearing loss and identify those factors contributing to delay in identification and intervention.
Design:
This is a retrospective case series. Children with sensorineural hearing loss who underwent auditory brainstem response (ABR) testing, hearing aid evaluation, or cochlear implant mapping at our tertiary pediatric medical center between January 2018 and December 2021 were included. Simple and multiple linear regression analyses were used to identify social, demographic, and health factors associated with primary outcomes, defined as age at hearing loss identification, age at intervention (here defined as amplification start), and interval between identification and intervention.
Results:
Of 132 patients included, mean age was 2.4 years, 48% were male, and 51% were Hispanic. There was significant association between each Hispanic ethnicity ( p = 0.005, p = 0.04, respectively), insurance type ( p = 0.02, p = 0.001, respectively), and later age at identification and intervention. In multivariable analyses, Hispanic ethnicity was significantly associated with both delays in identification and intervention ( p = 0.03 and p = 0.03, respectively), and public insurance was associated with delays in intervention ( p = 0.01). In addition, the total number of ABRs was significantly associated with both older age of identification and intervention ( p < 0.001, p < 0.001, respectively). Mediator analysis demonstrated that the effect of ethnicity on age at identification is mediated by the total number of ABRs performed.
Conclusions:
A significant association between total number of ABRs and age at identification and intervention for children with hearing loss exists. Hispanic ethnicity was associated with delays in meeting milestones, further mediated by the number of ABRs, providing a potential avenue for intervention in addressing this disparity.
