(0213) Disparities in Adult Cochlear Implantation in Georgia: Addressing Barriers in Access to Care

Introduction: This study aims to highlight demographic disparity and barriers to cochlear implantation in Georgia through analyses of CI incidence rates, patient demographics, and the impact of the pandemic. Georgia ranks 42nd in audiology services in the US and lacks a school of audiology, further exacerbating the gap in hearing care.

Methods: This retrospective cross-sectional study was conducted using de-identified cochlear implantation (CI) data obtained from the Healthcare Cost and Utilization Project Georgia State Ambulatory Surgery Database in the years 2018-2020. This data was combined with CIs performed at a large tertiary care institution during the same timeframe. Included patients were adults aged 18 or older undergoing CI. We analyzed sociodemographic factors, geographic distribution, and incidence of CI for each year by age group. Population estimates for severe-to-profound hearing loss were extracted from Census and National Health and Nutrition Examination Survey data.

Results: A total of 526 adults ages 18 years and older underwent CI in Georgia from 2018-2020. When comparing racial disparity with regional distribution, Black patients represented 14.4% of all CIs performed in 2018-2020 – less than their state proportion of 31.4%. White patients comprised 79.1% of CIs and make up 59% of the state population. Within primary payer status, 61.2% of Georgia CI recipients had public health insurance, whereas 33.5% had private insurance. Although 10% of adults in Georgia are on Medicaid, only 1.5% of all CI recipients in 2018-2020 had Medicaid. The incidence of CI among adult CI candidates (bilateral severe-to-profound hearing loss) in 2019 was 255 per 100,000 person-years, significantly lower when compared with the national CI incidence of 350 per 100,000 in the same year (p < 0.001).

Conclusions: Our data demonstrate a significant disparity in cochlear implantation in Georgia when compared with national estimates. This research underscores the importance of targeted state-wide legislative interventions addressing accessibility barriers to CI, particularly for minority and underserved populations.