Keywords
Health status disparities
Child health
Child language
Hearing loss
Sensorineura hypoacusia
Categories
How to Cite
Abstract
Introduction: Pediatric hearing loss, especially sensorineural, severely affects language, cognition, and social integration. Early detection and intervention are crucial to reduce its impact. However, disparities in access to cochlear implants persist globally, influenced by sociodemographic factors and social determinants of health. Addressing these inequities early in life is vital for improving auditory outcomes and reducing health disparities. The objective was to analyze recent literature on disparities in pediatric access to cochlear implants, identifying key factors contributing to unequal access and outcomes. Methods: A systematic review was conducted of literature published from 2020 to 2024 in PubMed, Scopus, and Google Scholar. The search, following PRISMA guidelines, took place between July and August 2024. Inclusion criteria focused on quantitative studies in English evaluating disparities in pediatric CI access using validated instruments. Out of 2,288 articles, five met eligibility for detailed analysis. Results: The selected studies showed that socioeconomic factors—such as insurance type, income, geographic location, and parental education—are consistently linked to delayed treatment and poorer developmental outcomes. These disparities were evident across different healthcare systems and regions. Conclusions: Socioeconomic inequalities remain significant barriers to timely pediatric cochlear implantation, affecting auditory development. Policy efforts are needed to ensure equitable access and improved outcomes.
References
Eisenberg LS, Johnson KC, Martinez AS, Visser-Dumont L, Ganguly DH, Still JF. Studies in pediatric hearing loss at the House Research Institute. Vol. 23, Journal of the American Academy of Audiology. 2012.
Estrella-Castillo DF, Rubio-Zapata H, Gómez-de-Regil L. Auditory perception of Mexican children with profound bilateral hearing loss receiving auditory verbal therapy. Child Lang Teach Ther. 2021;37(1):5–17.
Sabbagh S, Amiri M, Khorramizadeh M, Iranpourmobarake Z, Nickbakht M. Neonatal Hearing Screening: Prevalence of Unilateral and Bilateral Hearing Loss and Associated Risk Factors. Cureus. 2021;
INEGI. A Propósito Del Día Internacional De Las Personas Con Discapacidad [Internet]. Instituto Nacional de estadística y geografía. 2015. Available from: http://www.inegi.org.mx/saladeprensa/aproposito/2015/disca pacidad0.pdf
Leguizamón SY, García Agudelo L, Espejo Laiton H, Agudelo Ariza L, Núñez Hernández GE, Vargas Rodríguez LJ. Prevalencia de hipoacusia neonatal de la población atendida en el Hospital Regional de la Orinoquía, 2018: Estudio de tamizaje Auditivo Neonatal. Cienc Innov Salud. 2021;
Ospina-Garcia JC, Perez-Garcia IC, Guerrero D, Sanchez-Solano NJ, Salcedo-Betancourt JD. Prevalence of sensorineural hearing loss in newborns in a hospital from a developing country. Revista de Salud Publica. 2019;21(1):56–63.
AAP. American Academy of Pediatrics Joint Committee on Infant Hearing Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4).
Hacker K, Houry D. Social Needs and Social Determinants: The Role of the Centers for Disease Control and Prevention and Public Health. Public Health Reports. 2022;137(6):1049–52.
Schuh M, Bush ML. Defining Disparities in Cochlear Implantation through the Social Determinants of Health. Semin Hear. 2021;42(4):321–30.
Bazzazian S, Ozgoli G, Riazi H, Mahmoodi Z, Vafa M, Nasiri M. The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis. BMC Public Health. 2023;23(1).
Fagan JJ, Tarabichi M. Cochlear implants in developing countries: Practical and ethical considerations. Vol. 26, Current Opinion in Otolaryngology and Head and Neck Surgery. 2018. p. 188–9.
Stern RE, Yueh B, Lewis C, Norton S, Sie KCY. Recent epidemiology of pediatric cochlear implantation in the United States: Disparity among children of different ethnicity and socioeconomic status. Laryngoscope. 2005;115(1 I):125–31.
Leigh JR, Dettman SJ, Dowell RC. Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation. Int J Audiol. 2016;55:S9–18.
Mahendran GN, Rosenbluth T, Featherstone M, Vivas EX, Mattox DE, Hobson CE. Racial Disparities in Adult Cochlear Implantation. Otolaryngology - Head and Neck Surgery (United States). 2022;166(6):1099–105.
Tolisano AM, Schauwecker N, Baumgart B, Whitson J, Kutz JW, Isaacson B, et al. Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program. Annals of Otology, Rhinology and Laryngology. 2020;129(4):347–54.
Quimby AE, Venkatesh S, Corsten M, McDonald JT, Hwa TP, Bigelow DC, et al. Socioeconomic Status among Cochlear Implant Candidates and Association with Surgical Pursuance. JAMA Otolaryngol Head Neck Surg. 2023;149(10):891–8.
Yepes-Nuñez JJ, Urrútia G, Romero-García M, Alonso-Fernández S. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol. 2021;74(9):790–9.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Revista Panamericana de Salud Publica/Pan American Journal of Public Health. 2022;46(372):1–9.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Online). 2017;358.
Shea BJ, Wells G, Thuku M, Hamel C, Moran J, Moher D, et al. AMSTAR 2 Tool. Bmj. 2017;18(1).
Lipschitz N, Kohlberg GD, Scott M, Smith MM, Greinwald JH. Socioeconomic Disparities in Pediatric Single-Sided Deafness. Otolaryngology - Head and Neck Surgery (United States). 2020;163(4).
Dham R, Dharmarajan S, Kurkure R, Sampath Kumar RN, Kameswaran M. Socio-demographic profile and its influences on rehabilitation in children undergoing revision cochlear implantation – MERF experience. Int J Pediatr Otorhinolaryngol. 2021;151.
Whelan R, McCoy JL, Omar M, Chi DH. Identifying barriers and considerations for cochlear implantation in Amish children. American Journal of Otolaryngology - Head and Neck Medicine and Surgery. 2021;42(2).
Liu X, Rosa-Lugo LI, Cosby JL, Pritchett C V. Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation. Otolaryngology - Head and Neck Surgery (United States). 2021;164(3).
Omar M, Qatanani A, Kaleem SZ, McKinnon BJ. Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review. Vol. 132, Laryngoscope. 2022.
Zhang J, Wang P, Han B, Ding Y, Pan L, Zou J, et al. Newborn hearing concurrent genetic screening for hearing impairment-A clinical practice in 58,397 neonates in Tianjin, China. Int J Pediatr Otorhinolaryngol. 2013;77(12):1929–35.
De Garcia BG, Gaffney C, Chacon S, Gaffney M. Overview of newborn hearing screening activities in Latin America. Revista Panamericana de Salud Publica/Pan American Journal of Public Health. 2011;29(3):145–52.
Yoshinaga-Itano C, Sedey AL, Wiggin M, Mason CA. Language outcomes improved through early hearing detection and earlier cochlear implantation. Otology and Neurotology. 2018;39(10):1256–63.
Liao EN, Yaramala N, Coulthurst S, Merrill K, Ho M, Kramer K, et al. Impact of Sociodemographic Disparities on Language Outcomes After Cochlear Implantation in a Diverse Pediatric Cohort. Otolaryngology - Head and Neck Surgery (United States). 2023;168(5):1185–96.
Madriz JJ. Hearing impairment in latin America: An inventory of limited options and resources. Int J Audiol. 2000;39(4):212–20.
Madriz JJ. Audiology in Latin America: Hearing impairment, resources and services. In: Scandinavian Audiology, Supplement. 2001. p. 85–92.
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Copyright (c) 2025 Juan Antonio Lugo-Machado, Martha Lucía Gutiérrez-Pérez, Diana Isabel Espinoza-Morales, Edgar Antonio Solano-García, Valeria Lozano-Lavado, Nashla Fayad-Fayad, Camilo Scarpetta-Rivas; Álvaro Andrés Bayona-Arteaga (Revisor IPAO); Julio Manuel Medina-Serrano, Araceli Zazueta-Cárdenas