The impact of social vulnerability in navigating cochlear implant care

Cochlear implants (CIs) substantially benefit individuals with hearing loss but remain underutilized, likely due to barriers in access. This study examined how social vulnerability affects preoperative hearing loss, evaluation delays, and likelihood of CI surgery among referred adults.

This retrospective study included 120 adults referred for CI evaluation (2018-2023) who missed ≥1 evaluation appointment. Social vulnerability was assessed using the CDC Social Vulnerability Index (SVI). Associations between SVI scores and clinical variables were analyzed using t-tests and regression models.

Higher social vulnerability correlated with younger age at referral (β = -17.9, p = 0.005) and at deafness diagnosis (β = -36.1, p = 0.007), greater travel distance (β = 124.3, p < 0.001), and longer intervals between missed appointments (β=31.1, p = 0.02). More vulnerable patients had shorter hearing-aid use, poorer audiometric thresholds, and worse word recognition scores (all p < 0.05). Overall surgical conversion was 52.6%, with non-significant trends toward lower rates in higher SVI quartiles (p = 0.10).

Social vulnerability operates upstream of implantation, shaping disease progression and care access. More vulnerable adults are diagnosed earlier in life, present with more severe hearing loss, travel farther, and experience greater delays between appointments. Interventions targeting logistical barriers-including telehealth, travel support, and patient navigation-may reduce disparities and improve CI access.