title: Redefining the survival of the fittest: communication disorders in the 21st century.
abstract: OBJECTIVE
  To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language.
  
  
  METHODS
  Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language.
  
  
  METHODS
  Analysis of epidemiological and economic data for industrialized countries, North America, and the United States.
  
  
  RESULTS
  Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product.
  
  
  CONCLUSIONS
  Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
authors.affiliation: Albert Einstein College of Medicine and Montefiore Medical Center, Department of Otolaryngology, Bronx, New York 10467, USA. ruben@aecom.yu.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Ruben
mesh_terms: D003147:Communication Disorders / Q000191:economics* / Q000453:epidemiology; D017281:Cost of Illness; D004651:Employment; D006801:Humans; D007806:Language Disorders / Q000191:economics / Q000453:epidemiology; D016272:Occupational Health; D009790:Occupations / Q000706:statistics & numerical data; D015995:Prevalence; D012923:Social Class; D013064:Speech Disorders / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology