Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Anthony M Tolisano, Natalie Schauwecker, Bethany Baumgart, Johanna Whitson, Joe Walter Kutz, Brandon Isaacson, Jacob B Hunter

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


OBJECTIVE: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery.

METHODS: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center.

RESULTS: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4).

CONCLUSION: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.

Original languageEnglish
Pages (from-to)347-354
Number of pages8
JournalAnnals of Otology, Rhinology and Laryngology
Issue number4
StatePublished - Apr 2020
Externally publishedYes


  • Age Factors
  • Cochlear Implantation/methods
  • Demography
  • Eligibility Determination/methods
  • Evaluation Studies as Topic
  • Female
  • Healthcare Disparities/statistics & numerical data
  • Hearing Loss, Sensorineural/epidemiology
  • Humans
  • Insurance Claim Review
  • Male
  • Middle Aged
  • Patient Selection
  • Referral and Consultation/statistics & numerical data
  • United States/epidemiology


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