title: Rurality and determinants of hearing healthcare in adult hearing aid recipients.
abstract: The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients.
  
  
  
  Cross-sectional questionnaire survey.
  
  
  
  We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI).
  
  
  
  The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = -0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants.
  
  
  
  Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations.
  
  
  
  4. Laryngoscope, 127:2362-2367, 2017.
authors.affiliation: University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A.
authors.forename: Stephen
authors.initials: S
authors.lastname: Chan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Brian
authors.initials: B
authors.lastname: Hixon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Margaret
authors.initials: M
authors.lastname: Adkins
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
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
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006309:Hearing / Q000502:physiology*; D006310:Hearing Aids; D034381:Hearing Loss / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D006320:Hearing Tests; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012424:Rural Population; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
keywords: adult hearing loss; health disparities; hearing aids; socioeconomic factors