Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation

Otolaryngol Head Neck Surg. 2021 Mar;164(3):667-674. doi: 10.1177/0194599820953381. Epub 2020 Sep 15.


Objective: To evaluate the association between race/ethnicity and insurance status on the access to early cochlear implantation.

Study design: Population-based retrospective analysis of pediatric cochlear implantation procedures.

Setting: State Ambulatory Surgery and Services Databases of Florida from 2005 to 2017.

Methods: All children aged 18 years or younger in the state of Florida undergoing cochlear implantation were identified. The outcome measures were access to early cochlear implantation (before 1 and 2 years of age). Descriptive and multivariate logistic regression analyses were conducted.

Results: Among 1511 pediatric cochlear implantation procedures with complete data, 65 (4.3%) procedures were performed by 1 year of age and 348 (23.0%) by 2 years of age. Black children (odds ratio [OR], 0.44; 95% CI, 0.28-0.70), Hispanic children (OR, 0.70; 95% CI, 0.52-0.94), and children with Medicaid (OR, 0.64; 95% CI, 0.48-0.84) were significantly less likely to be implanted before 2 years of age. Even when insured by private insurance, black and Hispanic children were still less likely to be implanted before 2 years of age compared to white children with private insurance. Greater racial and insurance disparities existed in access to cochlear implantation before 1 year of age compared to implantation before 2 years of age.

Conclusion: Racial/ethnic and insurance disparities in pediatric cochlear implantation can be observed at the population level. To address these racial and insurance inequalities, a multidisciplinary care team is needed and priorities should be given to research endeavors and policy interventions that target these disparities.

Keywords: State Ambulatory Surgery and Services Databases (SASD); cochlear implantation; disparities; insurance; pediatric; race.

Publication types

  • Comparative Study

MeSH terms

  • Black or African American / statistics & numerical data*
  • Child, Preschool
  • Cochlear Implantation / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Infant
  • Insurance Coverage / statistics & numerical data*
  • Male
  • Retrospective Studies
  • White People / statistics & numerical data*