Department of Audiology, Nova Southeastern University, Davie, FL.
Consultant, Private Practice.
Am J Audiol. 2022 Sep;31(3):764-788. doi: 10.1044/2022_AJA-21-00014. Epub 2022 May 25.
The purpose of this study was to (a) provide introductory literature regarding cultural constructs, health disparities, and social determinants of health (SDoH); (b) summarize the literature regarding the Centers for Disease Control and Prevention (CDC) Early Hearing Detection and Intervention (EHDI) Hearing Screening Follow-Up Survey (HSFS) data; (c) explore the CDC EHDI HSFS data regarding the contribution of maternal demographics to loss-to-follow-up/loss-to-documentation (LTF/D) between hearing screening and audiologic diagnosis for 2016, 2017, and 2018; and (d) examine these health disparities within the context of potential ethnoracial biases.
This is a comprehensive narrative literature review of cultural constructs, hearing health disparities, and SDoH as they relate to the CDC EHDI HSFS data. We explore the maternal demographic data reported on the CDC EHDI website and report disparities for maternal age, education, ethnicity, and race for 2016, 2017, and 2018. We focus on LTF/D for screening and diagnosis within the context of racial and cultural bias.
A literature review demonstrates the increase in quality of the CDC EHDI HSFS data over the past 2 decades. LTF/D rates for hearing screening and audiologic diagnostic testing have improved from higher than 60% to current rates of less than 30%. Comparisons of diagnostic completion rates reported on the CDC website for the EHDI HSFS 2016, 2017, and 2018 data show trends for maternal age, education, and race, but not for ethnicity. Trends were defined as changes more than 10% for variables averaged over a 3-year period (2016-2018).
Although there have been significant improvements in LTF/D over the past 2 decades, there continue to be opportunities for further improvement. Beyond neonatal screening, delays continue to be reported in the diagnosis of young children with hearing loss. Notwithstanding the extraordinarily diverse families within the United States, the imperative is to minimize such delays so that all children with hearing loss can, at the very least, have auditory accessibility to spoken language by 3 months of age. Conscious awareness is essential before developing a potentially effective plan of action that might remediate the problem.
本研究旨在：(a)提供有关文化结构、健康差异和健康社会决定因素（SDoH）的文献介绍；(b)总结疾病控制与预防中心（CDC）早期听力检测和干预（EHDI）听力筛查随访调查（HSFS）数据的文献；(c)探讨 2016、2017 和 2018 年 CDC EHDI HSFS 数据中，母亲人口统计学特征对听力筛查和听力学诊断之间失访/失记录（LTF/D）的贡献；(d)在潜在的民族种族偏见的背景下检查这些健康差异。
这是对文化结构、听力健康差异和 SDoH 与 CDC EHDI HSFS 数据相关的综合叙述性文献综述。我们探讨了 CDC EHDI 网站上报告的母亲人口统计学数据，并报告了 2016、2017 和 2018 年母亲年龄、教育、族裔和种族的差异。我们重点关注种族和文化偏见背景下筛查和诊断的 LTF/D。
文献综述表明，过去 20 年来，CDC EHDI HSFS 数据的质量有所提高。听力筛查和听力学诊断测试的 LTF/D 率已从高于 60%降至目前的低于 30%。对 CDC 网站上报告的 EHDI HSFS 2016、2017 和 2018 年数据的诊断完成率的比较显示，母亲年龄、教育和种族存在趋势，但族裔没有趋势。趋势定义为在 3 年期间（2016-2018 年）平均变量变化超过 10%。
尽管在过去 20 年中 LTF/D 有了显著改善，但仍有进一步改进的机会。除了新生儿筛查外，在诊断幼儿听力损失方面仍有延迟的报告。尽管美国的家庭极其多样化，但必须尽量减少这种延迟，以便所有有听力损失的儿童至少在 3 个月大时能够通过听觉获得口语。在制定可能解决问题的有效行动计划之前，意识的觉醒是必不可少的。
