Socioeconomic and Demographic Trends of Cochlear Implant Recipients Who Use Sign Language: A National Database Analysis

Purpose: The purpose of this study was to examine how the socioeconomic and demographic characteristics of American Sign Language (ASL)-communicating people with cochlear implants differ from those of the broader cochlear implant (CI) recipient population. Method: In this cross-sectional study, we identified 39,111 patients receiving CIs between 2015 and 2024 using the Epic Cosmos database. Of those, 1,070 (2.7%) people with cochlear implants indicated ASL as their preferred language. Chi-square, Fisher's exact, and two-sample t tests compared differences between ASL communicators and noncommunicators in terms of age, sex, race, ethnicity, insurance, explantation, socioeconomic status (SES)/social vulnerability index (SVI), and urban/rural categories. Univariate and multivariate analyses evaluated the association between these variables and explantation. Results: Pediatric ASL communicators were significantly older than pediatric noncommunicators, whereas adult ASL users were younger. Female ( OR = 1.33), Hispanic ( OR = 2.51), and urban ( OR = 1.65) patients had increased odds of communicating with ASL. ASL users were more likely to be in the most vulnerable SES ( OR = 1.69) and SVI ( OR = 1.71) groups and undergo explantation ( OR = 2.41). Multivariate analysis identified ASL ( OR = 2.55) as the main associated variable with explantation. Pediatric patients were also associated with increased odds of being explanted ( OR = 1.31). Conclusions: There are socioeconomic and demographic differences between Deaf people with cochlear implants and the general CI recipient population. Deaf identity may intersect with health considerations such as CI explantation, highlighting the need for culturally informed approaches to patient care.