Investigating Socioeconomic Barriers to Cochlear Implantation

Objective: To explore socioeconomic disparities in cochlear implant evaluation (CIE) referrals and cochlear implantation.Study Design: Retrospective chart review.Setting: Tertiary referral academic center.Methods: Adult patients (n = 271) with an audiogram performed between 2015 and 2019 with a pure-tone average of at least 60 dB and word recognition score of 60% or less in the better-hearing ear or no word recognition score performed were included to determine if socioeconomic factors influenced the rate of referral to CIE and cochlear implantation.Results: There were 122 insured patients referred to CIE where 84 were considered cochlear implant (CI) candidates and 73 were implanted. In multivariate regression analysis, non-English-speaking patients were referred to CIE at lower rates (p < 0.01) than English-speaking patients. Patients who met the CI candidacy criteria with private insurance (p = 0.03) or Medicare with private insurance supplement (p = 0.03) had higher rates of cochlear implantation than those with Medicare or Medicaid. Of the uninsured patients (n = 22), 3 were referred to CIE and 2 were considered CI candidates. No uninsured patients received a CI.Conclusions: Primary language spoken was associated with a disparity in rates of CIE referral. Insurance type did influence rate of cochlear implantation once patients completed CIE and were considered CI candidates. Additional research is needed to implement strategies for more inclusive treatment.