Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case-Control Study.
cochlear implantation
race
socioeconomic
surgery
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
29 Dec 2023
29 Dec 2023
Historique:
revised:
28
11
2023
received:
04
06
2023
accepted:
11
12
2023
medline:
2
1
2024
pubmed:
2
1
2024
entrez:
30
12
2023
Statut:
aheadofprint
Résumé
Despite undergoing thorough cochlear implant (CI) candidacy evaluation and counseling, some patients ultimately elect against implantation. This study sought to identify patient-related and socioeconomic factors predicting CI deferral. A retrospective study of adult (≥18 years old) CI candidates presenting between 2007 and 2021 at a tertiary academic CI center was performed. The primary outcome was device implantation. Data collected included age, gender, hearing status, race, zip code of residence, median family income (MFI), distance traveled from the CI center, marital status, employment status, and insurance status. Multivariable binary logistic regression was performed to identify predictors of implantation. A total of 200 patients qualifying for CI were included, encompassing 77 adults deferring surgery (CI-deferred) and 123 consecutive adults electing for surgery (CI-pursued). Age, gender, hearing status, insurance type, employment status, distance from the implant center, and MFI were comparable between the groups (p > 0.05). Compared to CI-pursued patients, CI-deferred patients were more likely to be non-Caucasian (24.7% vs. 9.8%, p = 0.015) and unmarried (55.8% vs. 38.2%, p = 0.015). On multivariable logistic regression, older age (OR 0.981, 0.964-0.998, p = 0.027), African American race (OR 0.227, 0.071-0.726, p = 0.012), and unmarried status (OR 0.505, 0.273-0.935, p = 0.030) were independent predictors of implant deferral. This study demonstrates that increasing age at evaluation, African American race, and unmarried status are predictors for deferring CI surgery despite being implant candidates. These patients may benefit from increased outreach in the form of counseling, education, and social support prior to undergoing CI surgery. 3 - retrospective study with internal control group Laryngoscope, 2023.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIDCD NIH HHS
ID : 1K08DC020761-01
Pays : United States
Informations de copyright
© 2023 The American Laryngological, Rhinological and Otological Society, Inc.
Références
Sorkin DL, Buchman CA. Cochlear implant access in six developed countries. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2016;37(2):e161-e164. https://doi.org/10.1097/MAO.0000000000000946.
Sorkin DL. Cochlear implantation in the world's largest medical device market: utilization and awareness of cochlear implants in the United States. Cochlear Implants Int. 2013;14(Suppl 1):S4-S12. https://doi.org/10.1179/1467010013z.00000000076.
Nassiri AM, Sorkin DL, Carlson ML. Current estimates of Cochlear implant utilization in the United States. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2022;43(5):e558-e562. https://doi.org/10.1097/MAO.0000000000003513.
Cohen SM, Labadie RF, Haynes DS. Primary care approach to hearing loss: the hidden disability. Ear Nose Throat J. 2005;84(1):2629-3144.
Buchman CA, Gifford RH, Haynes DS, et al. Unilateral Cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: a systematic review and consensus statements. JAMA Otolaryngol Head Neck Surg. 2020;146(10):942-953. https://doi.org/10.1001/jamaoto.2020.0998.
Holder JT, Reynolds SM, Sunderhaus LW, Gifford RH. Current profile of adults presenting for preoperative Cochlear implant evaluation. Trends Hear. 2018;22:2331216518755288. https://doi.org/10.1177/2331216518755288.
Tolisano AM, Schauwecker N, Baumgart B, et al. Identifying disadvantaged groups for Cochlear implantation: demographics from a large Cochlear implant program. Ann Otol Rhinol Laryngol. 2020;129(4):347-354. https://doi.org/10.1177/0003489419888232.
Mangan AR, Davis KP, Anzalone CL, Saadi RA, Dornhoffer JL, King DL. Assessing patient barriers to Cochlear implantation. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2022;43(10):e1090-e1093. https://doi.org/10.1097/MAO.0000000000003702.
Reed NS, Altan A, Deal JA, et al. Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngol Head Neck Surg. 2019;145(1):27-34. https://doi.org/10.1001/jamaoto.2018.2875.
Huddle MG, Goman AM, Kernizan FC, et al. The economic impact of adult hearing loss: a systematic review. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1040-1048. https://doi.org/10.1001/jamaoto.2017.1243.
Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet (London, England). 2017;390(10113):2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6.
Neve OM, Boerman JA, van den Hout WB, Briaire JJ, van Benthem PPG, Frijns JHM. Cost-benefit analysis of Cochlear implants: a societal perspective. Ear Hear. 2021;42(5):1338-1350. https://doi.org/10.1097/AUD.0000000000001021.
Skarzynski PH, Ciesla K, Lorens A, Wojcik J, Skarzynski H. Cost-utility analysis of bilateral Cochlear implantation in adults with severe to profound sensorineural hearing loss in Poland. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2021;42(5):706-712. https://doi.org/10.1097/MAO.0000000000003040.
Foteff C, Kennedy S, Milton AH, Deger M, Payk F, Sanderson G. Cost-utility analysis of Cochlear implantation in Australian adults. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2016;37(5):454-461. https://doi.org/10.1097/MAO.0000000000000999.
Crowson MG, Semenov YR, Tucci DL, Niparko JK. Quality of life and cost-effectiveness of Cochlear implants: a narrative review. Audiol Neurootol. 2017;22(4-5):236-258. https://doi.org/10.1159/000481767.
Cheung LL, Fowler A, Hassarati RT, Birman CS. Distance and Socieoeconomic status as barriers to Cochlear implantation. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2023;44(2):134-140. https://doi.org/10.1097/MAO.0000000000003765.
Henkin Y, Shapira Y, Yaar SY. Current demographic and auditory profiles of adult cochlear implant candidates and factors affecting uptake. Int J Audiol. 2022;61(6):483-489. https://doi.org/10.1080/14992027.2021.1941327.
2018 Median Household Income in the United States. 2018.
Wick CC, Kallogjeri D, McJunkin JL, et al. Hearing and quality-of-life outcomes after Cochlear implantation in adult hearing aid users 65 years or older: a secondary analysis of a nonrandomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2020;146(10):925-932. https://doi.org/10.1001/jamaoto.2020.1585.
Wichova H, Mills D, Beatty S, Peng K, Miller M. Cochlear implantation performance outcomes in patients over 80 years old. Laryngoscope Investig Otolaryngol. 2022;7(3):847-853. https://doi.org/10.1002/lio2.825.
Kay-Rivest E, Schlacter J, Waltzman SB. Cochlear implantation outcomes in the older adult: a scoping review. Cochlear Implants Int. 2022;23(5):280-290. https://doi.org/10.1080/14670100.2022.2091723.
Spitzer ER, Waltzman SB. Outcomes of cochlear implantation in adults over 85 years of age. Cochlear Implants Int. 2021;22(5):296-302. https://doi.org/10.1080/14670100.2021.1913331.
Amin N, Wong G, Nunn T, Jiang D, Pai I. The outcomes of Cochlear implantation in elderly patients: a single United Kingdom center experience. Ear Nose Throat J. 2021;100(5_suppl):842S-847S. https://doi.org/10.1177/0145561320910662.
Bleich SN, Findling MG, Casey LS, et al. Discrimination in the United States: experiences of black Americans. Health Serv Res. 2019;54(Suppl 2):1399-1408. https://doi.org/10.1111/1475-6773.13220.
Lovett B, Welschmeyer A, Johns JD, Mowry S, Hoa M. Health disparities in otology: a PRISMA-based systematic review. Otolaryngol Neck Surg off J Am Acad Otolaryngol Neck Surg. 2022;166(6):1229-1237. https://doi.org/10.1177/01945998211039490.
Nieman CL, Marrone N, Szanton SL, Thorpe RJJ, Lin FR. Racial/ethnic and socioeconomic disparities in hearing health care among older Americans. J Aging Health. 2016;28(1):68-94. https://doi.org/10.1177/0898264315585505.
Dornhoffer JR, Holcomb MA, Meyer TA, Dubno JR, McRackan TR. Factors influencing time to Cochlear implantation. Otol Neurotol off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2020;41(2):173-177. https://doi.org/10.1097/MAO.0000000000002449.
Findling MG, Bleich SN, Casey LS, et al. Discrimination in the United States: experiences of Latinos. Health Serv Res. 2019;54(Suppl 2):1409-1418. https://doi.org/10.1111/1475-6773.13216.
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52-59. https://doi.org/10.1097/00005650-200201000-00007.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.
Zajacova A, Lawrence EM. The relationship between education and health: reducing disparities through a contextual approach. Annu Rev Public Health. 2018;39:273-289. https://doi.org/10.1146/annurev-publhealth-031816-044628.
Sims S, Houston L, Schweinzger I, Samy RN. Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program. Curr Opin Otolaryngol Head Neck Surg. 2017;25(5):365-369. https://doi.org/10.1097/MOO.0000000000000399.
Joseph AR. Hearing health outcomes as a function of age, gender, and diversity. Semin Hear. 2022;43(4):324-338. https://doi.org/10.1055/s-0042-1758377.
Jorgensen LE, Barrett RE. Relating factors and trends in hearing device adoption rates to opportunities for hearing health care providers. Semin Hear. 2022;43(4):289-300. https://doi.org/10.1055/s-0042-1758374.
Duijvestijn JA, Anteunis LJC, Hoek CJ, Van Den Brink RHS, Chenault MN, Manni JJ. Help-seeking behaviour of hearing-impaired persons aged > or = 55 years; effect of complaints, significant others and hearing aid image. Acta Otolaryngol. 2003;123(7):846-850. https://doi.org/10.1080/0001648031000719.
Hickson L, Meyer C, Lovelock K, Lampert M, Khan A. Factors associated with success with hearing aids in older adults. Int J Audiol. 2014;53(Suppl 1):S18-S27. https://doi.org/10.3109/14992027.2013.860488.
Scarinci N, Worrall L, Hickson L. Factors associated with third-party disability in spouses of older people with hearing impairment. Ear Hear. 2012;33(6):698-708. https://doi.org/10.1097/AUD.0b013e31825aab39.
Stark P, Hickson L. Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Int J Audiol. 2004;43(7):390-398. https://doi.org/10.1080/14992020400050050.
Ebrahimi-Madiseh A, Eikelboom RH, Bennett RJ, et al. What influences decision-making for Cochlear implantation in adults? Exploring barriers and drivers from a multistakeholder perspective. Ear Hear. 2020;41(6):1752-1763. https://doi.org/10.1097/AUD.0000000000000895.
Meyer C, Scarinci N, Ryan B, Hickson L. “This is a partnership between all of us”: Audiologists' perceptions of family member involvement in hearing rehabilitation. Am J Audiol. 2015;24(4):536-548. https://doi.org/10.1044/2015_AJA-15-0026.