The Follow-up Gap: Racial Disproportionality and Social Determinants of Health in New Jersey’s Hearing Detection and Intervention Program

Objectives. To assess how race/ethnicity and social determinants of health are related to loss to follow-up (LTF) from NJ’s Early Hearing Detection and Intervention (EHDI) program. Methods. All infants born in NJ between June 2015 and June 2017 referring for additional hearing healthcare after hospital discharge were considered for inclusion in this study. The sample consisted of 4,141 babies, 10.7% of which received no follow-up care. Step-wise multi-level logistic regression was used to determine how race/ethnicity, family-level, and community-level social determinants of health (SDOH) were predictive of LTF. Results. In each model, the odds of being LTF were significantly higher for infants of Black mothers compared to infants of White mothers. Family-level SDOH predictive of LTF included maternal age, WIC participation, and maternal education. While specific community-level SDOH were not predictive of LTF, they did improve model fit and reduced the amount of variance attributable to the counties in which infants were born and received initial hearing healthcare. Conclusions. Family-level SDOH explain some, but not all, of the differences in racial/ethnic disproportionality in follow-up from New Jersey’s EHDI program. Community-level SDOH exacerbated disproportionality for infants of Black mothers. Facilitators to follow-up include WIC participation and being Hispanic.