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Hearing Health Care for All

Gifford, René H., PhD

doi: 10.1097/01.HJ.0000542419.85807.bd
Editorial

Dr. Gifford is the director of the Cochlear Implant Program and the Cochlear Implant Research Laboratory at the Vanderbilt University Medical Center in Nashville, TN, where she's also a professor of hearing and speech sciences.

Racial and ethnic disparities in health care span nearly all medical subspecialties. Before the implementation of the Affordable Care Act (ACA), the primary underlying factors that drove racial and ethnic disparities were health care access and insurance coverage (e.g., CDC MMWR Supplement. 2013;62(3):1). While the ACA has significantly decreased the number of uninsured Americans and boosted the number of adults pursuing medical care, the issues of racial and ethnic disparities in health care access and utilization remain prevalent (Med Care. 2016 Feb;54(2):140; Ann Fam Med. 2017 Sep;15(5):434; Issue Brief (Commonw Fund). 2017 May;13:1).

Little has been studied about the relationship between race and ethnicity and hearing health care access and utilization of hearing technologies. Nieman and colleagues queried the National Health and Nutritional Examination Surveys (NHANES) database to document recent hearing assessment and regular hearing aid use among older adults (J Aging Health. 2016 Feb;28(1):68). They reported that black and Hispanic adults were significantly less likely than white adults to use hearing technology. Despite having a significantly lower rate of regular hearing aid use, black adults were more likely to have had a recent hearing assessment.

Particularly concerning in relation to racial and/or ethnic disparity in hearing technology use is the mounting evidence supporting a correlation between hearing loss and dementia (Aging Ment Health. 2014;18:671; The Lancet. 2017;390: 2673). The risk of developing dementia following hearing loss is significantly higher in black and Hispanic adults compared with white and non-Hispanic adults (J Am Geriatr Soc. 2017 Aug;65(8):1691). Bainbridge and Ramachandran found that non-Hispanic white adults had significantly greater hearing aid usage rates compared with both non-Hispanic black and Hispanic white adults. These hearing aid use data could not be explained by racial or ethnic hearing loss prevalence nor by the geographical demographics of the study population. Holder and colleagues reported on the demographic and audiologic profile of adults seen for preoperative cochlear implant (CI) evaluation in an urban academic medical center (Ear Hear. 2014 May-Jun;35(3):289). They reported that the racial composition of adults seeking audiologic evaluation for consideration of CI was not representative of the geographical areas from which the population was drawn. Specifically, there was an overrepresentation of white and Asian adults and an underrepresentation of black adults (they did not describe the ethnicity of preoperative CI patients).

There are multiple reports of racial and ethnic disparities in access to both hearing health care and hearing technology despite an increased hazard ratio for developing dementia following hearing loss in black and Hispanic adults. This should serve as a warning to us in audiology, otolaryngology, and other hearing health care professions: We are all responsible for taking part in reducing racial and ethnic disparities in hearing health. More than 466 million people across the world have disabling hearing loss (WHO, 2018). In the United States, hearing loss is among the top three most common chronic conditions, but it is largely treatable via hearing aids, implantable technology, and other assistive devices. We need to unite in our dedication to provide assessment, treatment, and prevention of hearing loss for all individuals. Closing this gap will require our attention, education, outreach with local partners, and conscious effort toward promoting equal access to hearing education and technology for people with hearing loss and those who are at risk. Who's ready for the challenge?

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