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Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentations 2 - Care Equity, Quality, and Safety

Understanding Hearing Loss and Cochlear Implantation Inequities Through the County Health Rankings System

Monday, October 13, 2025

8:48 AM - 8:54 AM EDT

Location: 107-108

Introduction: Cochlear implant (CI) utilization rates in the U.S. remain low. This study aims to identify social determinants of health associated with hearing loss (HL) and CI rates in the state of Virginia using the County Health Rankings (CHR), a system that evaluates and ranks every county in the U.S. based on six subcategories.

Methods: This retrospective study assessed county-level HL and CI rates per 100,000 for individual ZIP code tabulation areas (ZCTAs) from the Virginia All-Payer Claims Database (APCD) between 2016-2020. Correlations were assessed between CHR subcategory z-scores and HL and CI rates using a spatial lag model, while adjusting for race, poverty, unemployment, education, and population density.

Results: For the CHR, higher z-scores indicate a worse ranking and lower z-scores indicate a better ranking. Length of Life z-scores were positively associated with HL rate (RR = 1.70, 95% Confidence Interval: 1.54, 1.89, p<.01), as were Social & Economic Factors z-scores (RR=3.03, 95% Confidence Interval: 2.52, 3.65, p<.01), and Clinical Care z-scores (RR = 1.41, 95% Confidence Interval: 1.04, 1.92, p=.03). Health Behaviors z-scores were negatively associated with HL rate (RR=0.66, 95% Confidence Interval: 0.48, 0.91, p=.01). Physical Environment z-scores were negatively associated with CI rate (RR=.01, 95% Confidence Interval: <.01, 0.53, p=.02).

Conclusions: HL prevalence in Virginia has strong associations with various CHR metrics. The association between Physical Environment and CI rates and the lack of association with Social & Economic Factors demonstrate the significance of housing and transportation in CI utilization, more so than factors like income, education, and employment. These results can direct public health efforts to reduce inequities in hearing healthcare.

Presenting Author(s)

Emaan Dawood, BS

Medical Student
Virginia Commonwealth University School of Medicine
Richmond, VA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Lawrance Lee, MD

Otolaryngology Resident
Virginia Commonwealth University Health System
Richmond, VA, United States

Disclosure information not submitted.
RA

Rasha Alsaadawi, MS

Virginia Commonwealth University School of Public Health, United States

Disclosure information not submitted.
JL

Jong Hyung Lee, PhD

Virginia Commonwealth University School of Medicine, United States

Disclosure information not submitted.
RS

Roy Sabo, PhD

Virginia Commonwealth University School of Public Health, United States

Disclosure information not submitted.
Daniel H. Coelho, MD

G. Douglas Hayden Professor & Vice Chair
VCU Health Systems
Richmond, VA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

NM

Nauman Manzoor, MD

Virginia Commonwealth University Health System, USA

Disclosure information not submitted.