Social Determinants of Health and Impact on Cochlear Implant Performance

OBJECTIVE: To explore the association of social determinants of health (SDH) on postoperative speech perception outcomes in adult CI recipients. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic center. PATIENTS: Four hundred forty-seven post-lingually deafened adult CI recipients. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: The national Area Deprivation Index (ADI) is a ranking of neighborhood socioeconomic disadvantage with higher ADI suggesting greater disadvantage. The primary outcome was the change in ipsilateral CNC scores (delta CNC) at 3 months compared with pre-implant. Multivariable linear regression was used to explore the association of SDH factors on delta CNC scores at 3 months while controlling for confounders. RESULTS: The mean (SD) ADI of patients in this study was 54.6 (23.9). CNC scores at 3 months increased by a mean (SD) of 31.5% (25.7%). In multivariable regression models, there was a significant interaction effect between national ADI and insurance type on delta CNC. After controlling for age and preoperative pure-tone average (PTA), for patients with Medicare insurance, every additional point increase in ADI is associated with 0.08% decrease in delta CNC. For patients with commercial insurance, every additional point increase in ADI is associated with 0.12% increase in delta CNC. CONCLUSIONS: National ADI is a well-established measure for SDH and should be explored to better understand equitable CI health care. In patients with Medicare, there was a significant association between higher ADI and smaller delta in CNC speech perception scores. This association of SDH and CI outcomes raises critical questions that need to be explored through larger, more diverse studies to better advance equitable hearing health care.