Health Service Utilization in Children With Permanent Hearing Loss: A Nested Case Control Study
Janet Olds1,2,3, Elizabeth M Fitzpatrick2,4, Stuart G Nicholls5
1Children's Hospital of Eastern Ottawa, Ontario, Canada (CHEO).
Insights
Children with permanent hearing loss (PHL) experience more chronic complex conditions (CCCs) and utilize health services more frequently in their first two years. Early identification of PHL is crucial for optimizing care and health system planning.
Area of Science:
- Pediatric Health Services Research
- Audiology and Speech Pathology
- Public Health Policy
Background:
- Permanent hearing loss (PHL) affects approximately 40% of children with associated disabilities.
- Limited understanding exists regarding health service utilization patterns in children with PHL.
- Chronic complex conditions (CCCs) are common comorbidities in children with PHL.
Purpose of the Study:
- To compare health service utilization between children with PHL and matched controls.
- To investigate the prevalence of CCCs in children with PHL compared to controls.
- To analyze health service use in relation to PHL diagnosis era and CCCs.
Main Methods:
- A nested case-control study utilizing population-based health administrative data.
- Inclusion of 591 children with PHL and 2951 matched controls from a clinical database.
- Analysis of health services encounters and CCCs within two years postbirth, considering data from 1991-2013.
Main Results:
- Children with PHL had significantly higher rates of CCCs (39.9%) compared to controls (8.1%).
- PHL cases demonstrated increased health service utilization, including emergency visits (IRR 1.25), outpatient visits (IRR 1.44), and inpatient hospitalizations (IRR 1.62).
- The association between PHL and increased health service use remained significant after adjusting for CCCs and diagnosis era.
Conclusions:
- Children with PHL exhibit greater health service use and a higher burden of CCCs in early life.
- Early identification of permanent hearing loss is essential for improving child outcomes.
- Findings support the need for proactive health system planning to accommodate the needs of children with PHL.
Objective:
Permanent hearing loss (PHL) is accompanied by disabilities in approximately 40% of children but little is known about health service use. The objective was to compare health service utilization and chronic complex conditions (CCCs) in children with PHL with matched controls.
Study Design:
Nested case-control study: Data from children with PHL were linked to population-based health administrative data between January 1, 1991 and December 31, 2013, before and after implementation of the Early Hearing Detection and Intervention program in 2002.
Setting:
Tertiary care pediatric hospital.
Patients:
Population-based cohort of 591 children with PHL identified from a clinical database and 2951 matched controls.
Main Outcome Measures:
CCCs and health services encounters unrelated to hearing within 2 years postbirth. In multivariable models, independent variables were number of CCCs and era of PHL diagnosis.
Results:
PHL cases had more CCCs (39.9%) than matched controls (8.1%; P <.001) and made greater use of health services: by 2 years postbirth, this included more emergency (IRR 1.25, 95% CI: 1.08-1.46) and outpatient (IRR 1.44, 95% CI: 1.37-1.53) visits and longer inpatient hospitalization (IRR 1.62, 95% CI: 1.50-1.76) than controls. The association between PHL status and health services utilization remained significant after controlling for CCCs and era of PHL diagnosis.
Conclusions:
Children with PHL have higher health services use in the first 2 years of life, and are more affected by CCCs. Early identification of these children can optimize outcomes and help plan within the health system.
