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Assessment of appalachian region pediatric hearing healthcare disparities and delays
Author(s) -
Bush Matthew L.,
Osetinsky Mariel,
Shinn Jennifer B.,
Gal Thomas J.,
Ding Xiuhua,
Fardo David W.,
Schoenberg Nancy
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24588
Subject(s) - appalachian region , health care , health equity , audiology , geography , medicine , economics , economic growth , physical geography
Objectives/Hypothesis The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity. Study Design Retrospective analysis. Methods Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log‐rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed. Results A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis ( P = .006), amplification ( P = .030), and cochlear implantation( P = .002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis ( P = .028), amplification ( P =.087), and cochlear implantation ( P < .0001). Conclusions Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care. Level of Evidence 3b. Laryngoscope , 124:1713–1717, 2014