Su Brooke M, Park Jason S, Chan Dylan K
1 Department of Head & Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA.
2 School of Medicine, University of California-San Francisco, San Francisco, California, USA.
Otolaryngol Head Neck Surg. 2017 Oct;157(4):722-730. doi: 10.1177/0194599817725695. Epub 2017 Sep 12.
Objective This study aims to describe the effects of primary language and insurance status on care utilization among deaf or hard-of-hearing children under active otolaryngologic and audiologic care. Study Design Cross-sectional analysis. Setting Multidisciplinary hearing loss clinic at a tertiary center. Subjects and Methods Demographics, hearing loss data, and validated survey responses were collected from 206 patients aged 0 to 19 years. Two-sided t tests and χ tests were used to obtain descriptive statistics and hypothesis testing. Results Of the sample, 52.4% spoke primarily English at home. Non-English-speaking children and families were less likely to receive psychiatric counseling (12.2% vs 35.2% in the English group, P < .001) and reported more difficulty obtaining educational interventions ( P = .016), and 68.9% had public insurance. Parents of publicly insured children were less likely to know the type or degree of their child's hearing loss (56.9% vs 75.4%, P = .022), and these children were older on presentation to the clinic (8.5 vs 6.5 years of age, P = .01) compared to privately insured children. Publicly insured children were less likely to receive cochlear implants ( P = .046) and reported increased difficulty obtaining hearing aids ( P = .047). While all patients reported impairment in hearing-related quality of life, publicly insured children aged 2 to 7 years were more likely to perform below minimum thresholds on measures of auditory/oral functioning. Conclusion Even when under active care, deaf or hard-of-hearing children from families who do not speak English at home or with public insurance face more difficulty obtaining educational services, cochlear implants, and hearing aids. These findings represent significant disparities in access to necessary interventions.
目的 本研究旨在描述母语和保险状况对正在接受耳鼻喉科和听力学积极治疗的聋哑或听力障碍儿童医疗服务利用情况的影响。研究设计 横断面分析。研究地点 某三级中心的多学科听力损失诊所。研究对象和方法 收集了206名年龄在0至19岁患者的人口统计学资料、听力损失数据以及经过验证的调查回复。采用双侧t检验和χ检验进行描述性统计和假设检验。结果 在样本中，52.4%的人在家主要说英语。非英语母语的儿童及其家庭接受心理咨询的可能性较小（英语组为35.2%，非英语组为12.2%，P <.001），且报告在获得教育干预方面困难更多（P =.016），68.9%的人有公共保险。有公共保险儿童的父母了解其孩子听力损失类型或程度的可能性较小（分别为56.9%和75.4%，P =.022），与有私人保险的儿童相比，这些儿童到诊所就诊时年龄更大（分别为8.5岁和6.5岁，P =.01）。有公共保险的儿童接受人工耳蜗植入的可能性较小（P =.046），且报告在获得助听器方面困难增加（P =.047）。虽然所有患者都报告了听力相关生活质量受损，但2至7岁有公共保险的儿童在听觉/口语功能测量中更有可能低于最低阈值。结论 即使在接受积极治疗的情况下，在家不说英语或有公共保险家庭的聋哑或听力障碍儿童在获得教育服务、人工耳蜗植入和助听器方面面临更多困难。这些发现表明在获得必要干预措施方面存在显著差异。
