Socioeconomic Factors Delay Hearing Aids for Kids

Jennifer Garcia

October 11, 2019

Race/ethnicity, insurance type, and primary language may pose barriers to timely access to hearing aids among children, according to a new retrospective cohort study published October 10 in JAMA Otolaryngology – Head and Neck Surgery.

Lisa Zhang, BS, Jonathan Walsh, MD, and colleagues from the Johns Hopkins University School of Medicine, Baltimore, Maryland, evaluated the association between insurance type (private vs public), race/ethnicity, primary language, cause of hearing loss, ZIP code, and severity of hearing loss and the time intervals between newborn hearing screening (NHS), the first auditory brainstem response (ABR) test result, the ordering of hearing aids, and the dispensing of hearing aids.

Using medical record data, the authors identified 90 pediatric patients (<18 years) who underwent ABR testing and received hearing aids between March 2004 and July 2018. All patients were seen at a large tertiary hospital that provided services to both urban and rural populations in Maryland. The mean age of the patients was 5.6 years, 56% were girls, and 86% were non-Hispanic.

Insurance Type

The researchers found a significant association between insurance type and the time to first ABR test; for patients with public insurance, the interval was 13 months, compared with 7 months for those with private insurance (mean difference, 6.0 months; 95% confidence interval [CI], 1.8 – 10.2 months).

The authors indicate that although most public insurance options cover the cost of hearing aids, previous research has shown that other factors, such as services offered only at specific facilities or the cost of multiple appointments, may play a role in delaying access.


With respect to race/ethnicity, for white patients, the mean interval between NHS and first ABR was 6.3 months, compared with 12.3 months for patients of other race/ethnicity (mean difference, 6.0; 95% CI, 2.3 – 9.7 months).

The authors note, however, that previous studies have demonstrated that other variables, such as "cultural acceptance and awareness of infant hearing loss," may also pose a challenge to timely management.

Primary Language

Primary language also played a role in the time between NHS and ABR testing. Native English-speaking patients waited approximately 6 months less than patients whose primary language was other than English (mean interval, 9 months vs 14.9 months). The authors explain that the large CI for this difference (95% CI, –3.7 to 15.4 months) suggests that this is not a significant association. Rather, the authors posit that this association may be secondary to the association between language and insurance type and that families in which English is not the primary language and that have public insurance may have difficulty navigating the complex healthcare system and communicating with providers.

When all three potential barriers — race/ethnicity, insurance type, and primary language — were analyzed along with independent variables such as severity of hearing loss, complexity of medical condition, patient ZIP code, and hearing aid manufacturer, severity of hearing loss was consistently associated with a decrease in the interval from ABR testing to the ordering of hearing aids.

The authors acknowledge that institution-specific factors, including the demographic and socioeconomic characteristics of the patient population, may limit the generalizability of these findings. Further, the large range of outliers and small sample size for some subgroups could have skewed the results.

"The results of our study likely have implications for decision-making at the state and national levels because many of the potential barriers to access that we investigated are similar to those identified previously as barriers to diagnosis and treatment of other medical conditions," write the authors.

"We hope the results of our research will further the discussion of policies to eliminate these barriers to access for children at risk," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online October 10, 2019. Abstract

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.