(A856) Racial Disparities in Cochlear Implantation Rates and Hearing Aid Usage

Introduction: Recent literature has detailed racial disparities in obtaining cochlear implantation and hearing aid use. However, there are known racial differences in prevalence of hearing loss. This study investigates whether racial disparities in cochlear implantation (CI) rates, as well as hearing aid use rates, persist after adjusting for degree of hearing loss.

Methods: Data from adults aged ≥18 years in the 2005-2006, 2009-2010, 2011-2012, 2015-2016, and 2017-2020 NHANES were analyzed. Degree of hearing loss and CI candidacy were determined based on pure tone thresholds. CI candidacy for each racial group was compared to data from CI surgery incidence (2001-2018) using the National Inpatient Sample (NIS). Prevalence ratios for CI surgeries relative to CI candidates were calculated for two models with different CI candidacy cutoffs—severe vs profound hearing loss. Additionally, a logistic regression model adjusted for bilateral hearing loss and other covariates assessed the impact of race on hearing aid usage in NHANES.

Results: Model A found CI prevalence ratios were 0.73 for "White," 1.15 for "Non-Hispanic Black," 1.01 for "Hispanic," and 1.45 for "Other Race/Multiracial." Model B ratios were 0.74 for "White," 1.31 for "Non-Hispanic Black," 0.87 for "Hispanic," and 1.49 for "Other Race/Multiracial." Logistic regression revealed that "Non-Hispanic Black" individuals had significantly lower odds of hearing aid usage [OR = 0.50, 95% CI = 0.35 - 0.73, p < 0.001], and a similar association was found for "Hispanic" individuals [OR = 0.64, 95% CI = 0.42 - 0.99, p < 0.05].

Conclusions: This study suggests that some of the racial disparities identified for cochlear implantation may be confounded by racial differences in hearing loss severity. However, both the Black and Hispanic population appear to have persistent barriers to obtaining necessary hearing amplification.