(PP806) Geospatial and Socioeconomic Patterns of Patients Referred for Cochlear Implant Candidacy Evaluation

Abstract: This study aims to elucidate potential barriers to cochlear implantation by examining the referral patterns and follow-up attendance of patients at an adult cochlear implant center in North Carolina to better understand hearing health care disparities from geographic, economic, and social perspectives. The present analyses evaluated characteristics of patients referred for cochlear implant candidacy by their county-level socioeconomic status and geographic proximity to the center. 394 patients met the inclusion criteria for this study. Preliminary results and variables including clinic proximity, access to reliable transportation, and ability to request leave from work, will be discussed.

Summary: The issue of accessibility within health care is widely recognized; however, there is a limited body of research regarding access to cochlear implantation. Research demonstrates that patient characteristics (e.g., socioeconomic status and place of residence) and provider characteristics (e.g., clinic availability) impact access to hearing health care, particularly among patients with low socioeconomic status and those who reside in rural areas. These disparities likely also influence access to the preoperative and postoperative audiological and medical evaluations. In particular, the cochlear implant candidacy determination process involves several appointments with multiple providers, placing a high demand on patient resources, such as access to transportation, financial resources, and access to insurance. This study aims to elucidate potential barriers by examining the referral patterns and follow-up attendance of patients referred for cochlear implant candidacy evaluations at a center in North Carolina to better understand hearing health care disparities from geographic, economic, and social perspectives. 

A retrospective review was conducted to analyze the spatial distribution of referrals and follow-up outcomes stratified by geographic region and socioeconomic status. In order to better understand barriers to appointment attendance, geographic region was used to calculate drive time based on common routes, road types, and restrictions. Socioeconomic status was estimated broadly by using county-level data from the North Carolina Economic Distress Tiers rankings as a proxy. Referral data included the duration between the date of the initial referral and the subsequent date of candidacy evaluation, and characteristics of referred patients (e.g., unaided detection thresholds). Follow-up data included frequency of returning to the clinic for recommended follow-up intervals and incidence of appointment non-attendance to the initial candidacy evaluation. 

394 patients met the inclusion criteria for this study. Patients evaluated after the year 2019 were not included in this study in efforts to mitigate the impacts of COVID-19 as a confounding variable. Preliminary results suggest more patients are traveling to the clinic from regions of less economic distress, even as patients' drive time increases to greater than two hours. Patients traveling from areas of low socioeconomic status and/or rural areas have a prolonged amount of time between referral and evaluation, and are less frequent to return for recommended follow-up visits than patients traveling from areas of higher socioeconomic status and/or urban areas. Of note, a larger percentage of patients who did not attend the appointment lived more proximal to the clinic. Variables including clinic proximity, access to transportation, and ability to request leave from work will be discussed. 

As candidacy criteria for cochlear implantation continue to expand, accessibility to hearing health care services must follow suit. This study provides preliminary insight into some of the barriers to cochlear implant candidacy evaluations so that providers may find ways to strategically circumvent these issues, such as collaboration with satellite clinics or utilization of telehealth for virtual visits. Future research will aim to evaluate the success of existing interventions and to better evaluate factors that influence patients' ability to prioritize pursuing cochlear implantation in real-time.