title: Assessment of Appalachian region pediatric hearing healthcare disparities and delays.
abstract: OBJECTIVE
  The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed.
  
  
  RESULTS
  A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (P=.006), amplification (P=.030), and cochlear implantation (P=.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (P=.028), amplification (P=.087), and cochlear implantation (P<.0001).
  
  
  CONCLUSIONS
  Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care.
  
  
  METHODS
  3b.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.forename: Mariel
authors.initials: M
authors.lastname: Osetinsky
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gal
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Ding
authors.forename: David W
authors.initials: DW
authors.lastname: Fardo
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
mesh_terms: D001061:Appalachian Region / Q000453:epidemiology; D002648:Child; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D054625:Healthcare Disparities; D034381:Hearing Loss / Q000151:congenital / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012424:Rural Population; D014505:Urban Population
keywords: Health disparity; congenital hearing loss; rural healthcare