Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence.
Sarah Kingsbury, Nicole Khvalabov, Jonathan Stirn and 4 others
PMID 36275486WHAT IT FOUND
Children from lower-income families, rural areas, and non-English speaking homes face significant delays in hearing diagnosis and treatment.
Medicaid patients wait 13 months for diagnostic testing compared to 7 months for private insurance. Clinicians must actively use interpreters and culturally responsive practices to bridge these gaps.
Key findings
01Infants whose mothers held graduate degrees had their hearing loss confirmed on average 7 months earlier than infants whose mothers’ education levels were at or below a high school level.
02Children who had Medicaid insurance received their first diagnostic hearing evaluation 13 months after their newborn hearing screening, whereas children on private insurance received their first diagnostic test an average of 7 months after their screening.
03Caregivers who used English as their first language experienced much shorter periods of time between newborn hearing screening and diagnostic auditory brainstem response testing than caregivers who used a first language other than English (mean interval of 9 months vs. 15 months).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review, so the selection of studies may be biased toward the authors' perspectives. The review aggregates findings from various study designs (surveys, chart reviews, qualitative interviews) with differing levels of evidence. The paper notes that the underlying causes of disparities, such as systemic racism and privatized healthcare, are speculative and require further research. Many cited studies are older (e.g., 2010-2016), and healthcare policies and technology may have changed since publication.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the delays in diagnosis and intervention as solely a result of family non-compliance or lack of motivation. The review highlights that structural barriers, such as insurance reimbursement rates, distance to clinics, and lack of qualified pediatric audiologists, are primary drivers of these disparities.