Geographic and Sociodemographic Disparities in Early Hearing Detection and Intervention Adherence

Early identification and intervention are crucial to minimizing impacts of congenital hearing loss. Early Hearing Detection and Intervention (EHDI) programs recommend newborn hearing screening before one month of age and a diagnostic audiologic evaluation before three months for infants who do not pass the screening. However, not all infants meet these benchmarks, as geographic and sociodemographic factors may influence adherence. Addresses of primary contacts and audiology clinics were geocoded to calculate drive times to the nearest clinic in 10-minute intervals for infants born in Minnesota between 2019 and 2021. Birth location, NICU admittance, and sociodemographic characteristics were also analyzed. Random forest classifiers and logistic regressions identified key variables and optimizing models. The 1-month benchmark was met by 97.9% of infants, while 50.5% met the 3-month benchmark. For every ten additional audiology clinics within 30 minutes of driving, the odds of meeting the 1-month benchmark increased by 22% (p < 0.01). Each additional 10 minutes of drive time decreased the odds by 7.3% for the 1-month and 3.6% for the 3-month benchmarks (p < 0.01). Shorter drive times and more urban residences increase adherence to both benchmarks, while birth location, insurance coverage and educational attainment also played significant roles. Addressing these barriers is crucial for improving EHDI outcomes.