Association of Area Deprivation Index With Cochlear Implant Candidacy and Outcomes

To investigate whether neighborhood-level sociodemographic deprivation, measured by the Area Deprivation Index (ADI), is associated with speech recognition and hearing-related quality of life (QoL) prior to and following cochlear implant (CI) surgery.

A retrospective review of 515 adult CI recipients (2017-2022) was conducted. Home addresses were geocoded to ADI percentiles representing neighborhood-level sociodemographic deprivation. Assessments collected pre-CI and at 6- and/or 12-months post-CI included speech recognition (CNC words, AzBio sentences in quiet-AzBioQ, and in noise-AzBioN) and patient-reported outcome measures (Speech, Spatial and Qualities-12-SSQ, Cochlear Implant Quality of Life-10-CIQOL). Bivariate Spearman correlations and multivariable linear regressions controlling for age, sociodemographic variables, duration of deafness, and electrode type evaluated associations between ADI and assessment measures.

Participants from more deprived neighborhoods (i.e., with larger ADIs) demonstrated significantly poorer pre-CI CNC (r_s = -0.11), AzBioQ (r_s = -0.12), AzBioN (r_s = -0.18), SSQ (r_s = -0.13), and CIQOL (r_s = -0.30) (all p < 0.05). In multivariable models, larger ADI remained an independent predictor of poorer pre-CI speech recognition and worse CIQOL (p's < 0.05). However, ADI was not associated with any post-CI outcomes (p's > 0.05).

Greater neighborhood-level deprivation is associated with poorer speech recognition and patient-reported outcome measures at CI evaluation but not with postimplantation benefit. These findings suggest that socioeconomic disparities primarily influence access to intervention rather than outcomes following implantation. Incorporating ADI into clinical workflows may help identify patients at risk for delayed CI access.