Assessment of appalachian region pediatric hearing healthcare disparities and delays. (10th February 2014)

• Record Type: Journal Article
• Authors: Bush, Matthew L.; Osetinsky, Mariel; Shinn, Jennifer B.; Gal, Thomas J.; Ding, Xiuhua; Fardo, David W.; Schoenberg, Nancy
• Is Part Of: Laryngoscope. Volume 124:Number 7(2014:Jul.)
• Page Start: 1713
• Page End: 1717
• Publication Date: 2014-02-10
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24588
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24588-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>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.</p> </sec> <sec id="lary24588-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective analysis.</p> </sec> <sec id="lary24588-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="lary24588-sec-0004" sec-type="section"> <title>Results</title> <p>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 (<italic>P</italic> = .006), amplification (<italic>P</italic> = .030), and cochlear implantation(<italic>P</italic> = .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 (<italic>P</italic> = .028), amplification (<italic>P</italic>=.087), and cochlear implantation (<italic>P</italic> < .0001).</p> </sec> <sec id="lary24588-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> <sec id="lary24588-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>3b. <italic>Laryngoscope</italic>, 124:1713–1717, 2014</p> </sec> </abstract>