Speech Delay and Hearing Rehabilitation Disparities in Children With Hearing Loss.

Abstract

Objectives: To investigate the influence of race and insurance type on speech delay rates and hearing rehabilitation access in children with bilateral hearing loss (HL).

Study design: Retrospective cross-sectional study of pediatric patients with bilateral HL who received cochlear implants (CIs) or hearing aids (HAs).

Setting: This study used the national Pediatric Health Information System (PHIS) database to identify patients with HL across 52 tertiary care pediatric hospitals in the United States.

Methods: Data collected included demographics, CI/HA use, speech delay/disorders, and type of insurance coverage.

Results: This study identified 18,422 patients with bilateral HL (40.1% female, 66.3% white, 66.3% on public insurance), with an average age of 5.21 ± 4.37 years. Patients with private insurance were more likely to be white than non-white (48.9% vs 27.5%, P < .001), more likely to receive CI (18.0% vs 14.7%, P < .001), more likely to receive HA (21.3% vs 17.9%, P <.001), and less likely to have speech delay diagnoses (74.9% vs 81.0%, P < .001) compared to patients with public insurance. Compared to non-white patients, white patients were more likely to have CI (16.8% vs 14.7%, P < .001), more likely to have HA (20.6% vs 17.0%, P < .001), and less likely to have speech delay diagnoses (81.1% vs 77.2%, P < .001). When adjusting for other variables, these associations with insurance type and race were still observed.

Conclusion: Disparities seen amongst different races and income groups can be observed at the population level and highlight an opportunity for policy interventions to secure equitable access for children with pediatric HL.