Comparison of Socioeconomic Factors Influencing Delay and Underuse of Cochlear Implants

To evaluate and compare socioeconomic factors associated with underuse and prolonged time to cochlear implant (CI) surgery for qualifying candidates.

Retrospective cohort study of adult patients who were CI candidates from January 1, 2018, to December 31, 2022.

Three tertiary academic centers.

Demographic factors (age, sex, race, zip code, insurance status, preferred language, and marital status) and speech recognition scores in quiet and distance to CI center were collected. Household income quintiles were determined based on zip code matching to US Census data. Main outcomes were decision to pursue CI surgery and time elapsed from initial candidacy to surgery.

A total of 382 patients were evaluated for CI candidacy and included in the analysis (191 [50%] women; median age, 70 years; interquartile range [IQR] 58-78). Of these, 306 (80%) underwent cochlear implantation. Multivariable analyses revealed that, among those who qualified, patients with non-English-speaking status (odds ratio [OR] 0.31 [95% CI: 0.13-0.71]), older age (OR 0.97 [95% CI: 0.94-0.99]), male sex (OR 0.40 [95% CI: 0.23-0.72]), and higher speech recognition scores (21%-40%: OR 0.33 [95% CI: 0.15-0.70]; >41%: OR 0.24 [95% CI: 0.076-0.74]) were less likely to receive surgery. Among those who underwent surgery, only non-English-speaking patients experienced significantly longer time to surgery relative to English-speaking patients (hazard ratio [HR] 0.64 [95% CI: 0.43-0.97]).

Language is a potential enduring factor impacting both pursuit of and time to CI surgery. Future work should consider target strategies to account for these factors as a way to improve CI access.