Provider Perceptions Versus Observed Impacts of Social Determinants on Pediatric Cochlear Implant Follow-up

This study evaluated the perceived versus actual impact of social determinants of health on follow-up attendance including time to activation and recorded hours of use in pediatric patients with cochlear implants (CI).

A retrospective chart review included patients (0-18 yrs) who received a CI at a Northwell Health facility between August 1, 2013, and January 1, 2023. Social determinants assessed included race, immigration status, primary household language, insurance status, median household income, and zip code. Outcomes for CI patients included follow-up appointments after activation, at 6 months, 1 year, and 2-5 years.

Among 107 CI recipients, those who immigrated to the United States had fewer first-year follow-ups than US-born patients (born in the United States: 8.67 ± 1.97; immigrated: 6.38 ± 2.92; p  = 0.0060). Patients from lower-income areas had lower follow-up rates after activation and at 6 months (activation: low income-0.81 ± 0.39, middle income-0.95 ± 0.23; p  = 0.035; 6-mo follow-up: low income-0.75 ± 0.43, middle income-0.91 ± 0.29; p  = 0.033). At 2-5 years, follow-up rates were highest in patients from zip code 112 (Brooklyn, 4.5 ± 0.71) compared to 117 (Suffolk County, 2.22 ± 1.56) and 113 (Flushing, 1.16 ± 1.14) ( p  = 0.037 and 0.023, respectively). No significant associations were found between primary language, insurance status, or race. Provider surveys showed that all providers believed socioeconomic status (SES) affected follow-up, while 55.6% cited primary language and 33.3% cited immigration status and zip code.

Lower income and immigration status were associated with reduced follow-up among CI recipients, aligning with provider expectations. However, patients from lower-income urban areas required more frequent follow-ups in the long term, possibly due to poorer hearing outcomes or limited access to local providers. Providers had a negative bias regarding the influence of primary household language, insurance status, and race. While these factors may be associated with lower income and immigration status, they were not directly linked to follow-up adherence. These findings highlight the importance of identifying patients with established risk factors, such as low household income, immigration status, and geographic distance from treatment centers, and proactively engaging their families in discussions about potential barriers to follow-up care and involving social workers to help address these challenges to improve postsurgical follow-up adherence.