title: Targeting regional pediatric congenital hearing loss using a spatial scan statistic.
abstract: OBJECTIVE
  Congenital hearing loss is a common problem, and timely identification and intervention are paramount for language development. Patients from rural regions may have many barriers to timely diagnosis and intervention. The purpose of this study was to examine the spatial and hospital-based distribution of failed infant hearing screening testing and pediatric congenital hearing loss throughout Kentucky.
  
  
  METHODS
  Data on live births and audiological reporting of infant hearing loss results in Kentucky from 2009 to 2011 were analyzed. The authors used spatial scan statistics to identify high-rate clusters of failed newborn screening tests and permanent congenital hearing loss (PCHL), based on the total number of live births per county. The authors conducted further analyses on PCHL and failed newborn hearing screening tests, based on birth hospital data and method of screening.
  
  
  RESULTS
  The authors observed four statistically significant (p < 0.05) high-rate clusters with failed newborn hearing screenings in Kentucky, including two in the Appalachian region. Hospitals using two-stage otoacoustic emission testing demonstrated higher rates of failed screening (p = 0.009) than those using two-stage automated auditory brainstem response testing. A significant cluster of high rate of PCHL was observed in Western Kentucky. Five of the 54 birthing hospitals were found to have higher relative risk of PCHL, and two of those hospitals are located in a very rural region of Western Kentucky within the cluster.
  
  
  CONCLUSIONS
  This spatial analysis in children in Kentucky has identified specific regions throughout the state with high rates of congenital hearing loss and failed newborn hearing screening tests. Further investigation regarding causative factors is warranted. This method of analysis can be useful in the setting of hearing health disparities to focus efforts on regions facing high incidence of congenital hearing loss.
authors.affiliation: 1Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA; 2Department of Epidemiology, College of Public Health, Lexington, Kentucky, USA; 3College of Medicine, University of Kentucky, Lexington, Kentucky, USA; 4Cabinet for Health and Family Services, Commission for Children with Special Health Care Needs, Louisville, Kentucky, USA; and 5Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.forename: Warren Jay
authors.initials: WJ
authors.lastname: Christian
authors.forename: Kristin
authors.initials: K
authors.lastname: Bianchi
authors.forename: Cathy
authors.initials: C
authors.lastname: Lester
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
mesh_terms: D016000:Cluster Analysis; D016057:Evoked Potentials, Auditory, Brain Stem; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology*; D006320:Hearing Tests / Q000379:methods; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007629:Kentucky / Q000453:epidemiology; D015997:Neonatal Screening; D017084:Otoacoustic Emissions, Spontaneous; D062206:Spatial Analysis