{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:31:41Z","timestamp":1792477901872,"version":"4.5.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"\n Importance<\/jats:title>\n Despite the sizeable global burden of hearing loss, cochlear implants have poor penetrance among eligible hearing-impaired individuals. Identifying populations who may benefit from a cochlear implant but among whom penetrance is poor is an important aim in reducing the health-related and economic effects of hearing loss on both individuals and society.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To explore the association of socioeconomic status (SES) with cochlear implant candidacy and the decision to undergo cochlear implantation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was performed in a tertiary academic center. All adult patients evaluated for cochlear implant candidacy from January 1, 1999, through December 31, 2022, were included in the analysis.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Household income quintile and rural or urban residence were used as proxies for SES based on zip code linkage to US Census and US Department of Agriculture data.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Odds of cochlear implant candidacy and surgery.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 754 individuals underwent candidacy evaluations and were included in the analysis (386 [51.2%] women; mean [SD] age, 64.0 [15.7] years). Of these, 693 (91.9%) were cochlear implant candidates, and 623 candidates (89.9%) underwent cochlear implantation. Multivariable analyses demonstrated that individuals in the highest income quintile had lower odds of cochlear implant candidacy compared with those in the lowest income quintile (odds ratio [OR], 0.26 [95% CI, 0.08-0.91]), and candidates in the highest income quintile had greater odds of undergoing cochlear implant surgery compared with those in the lowest quintile (OR, 2.59 [95% CI, 1.14-5.86]). Living in a small town or a micropolitan or rural area was associated with lower odds of undergoing cochlear implant surgery compared with living in a metropolitan core (OR, 0.18 [95% CI, 0.04-0.83]) after controlling for distance to the primary implant center.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this cohort study suggest that individuals with higher SES are less likely to qualify for a cochlear implant; however, those who qualify are more likely to undergo surgery compared with those with lower SES. These findings highlight a hearing health care disparity that should be addressed through further studies to guide population-based initiatives.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2023.2217","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T11:32:12Z","timestamp":1692876732000},"page":"891","source":"Crossref","is-referenced-by-count":34,"title":["Socioeconomic Status Among Cochlear Implant Candidates and Association With Surgical Pursuance"],"prefix":"10.1001","volume":"149","author":[{"given":"Alexandra E.","family":"Quimby","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjena","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"currently a medical student at Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Corsten","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Ted","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany P.","family":"Hwa","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery, University of Pennsylvania, Philadelphia"},{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Bigelow","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Ruckenstein","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Johnson-Obaseki","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery, University of Pennsylvania, Philadelphia"},{"name":"Corporal Michael J. 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