Investigating Hearing Loss and Cochlear Implantation Disparities Through the County Health Rankings System

To determine the hearing loss (HL) and cochlear implantation (CI) rates of each Virginia county and correlate outcomes with the Virginia County Health Rankings (CHR) and American Community Survey (ACS) data.

Retrospective study analyzing county-level HL and CI rates.

The Virginia All-Payer Claims Database (APCD) between 2016 and 2020.

We assessed county-level HL and CI rates per 100,000 for individual zip-code tabulation areas from the Virginia APCD. The relationship between county-level HL and CI rates with Virginia CHR z-scores was then correlated using a spatial lag model, while adjusting for various ACS data points.

For the CHR, higher z-scores indicate a worse ranking and lower z-scores indicate a better ranking. Length of life z-scores were positively associated with HL rate (rate ratio [RR] = 1.70, 95% confidence interval: 1.54, 1.89, P < .01), as were social and economic factors z-scores (RR = 3.03, 95% confidence interval: 2.52, 3.65, P < .01), and clinical care z-scores (RR = 1.41, 95% confidence interval: 1.04, 1.92, P = .03). Health behaviors z-scores were negatively associated with HL rate (RR = 0.66, 95% confidence interval: 0.48, 0.91, P = .01). Physical environment z-scores were negatively associated with CI rate (RR = 0.01, 95% confidence interval: <0.01, 0.53, P = .02).

HL prevalence and CI in Virginia have strong associations with various CHR metrics. Physical environment factors (such as housing and transit) may help explain lower CI rates. More targeted population-level investigations are needed to further understand these associations and guide public health interventions.