Utilization of and access to quality hearing healthcare services influences overall health and hearing-related outcomes for adults and children. Considering the global underutilization of hearing devices, access to care is a critical issue for CI specialists and researchers to evaluate and address.

Healthcare Access and Quality and Cochlear Implantation

Education attainment intersects with other social determinants of health through its impact on income and higher wages which in turn affects access to healthy food, safe living environments, and insurance coverage. Therefore, there is a correlation between educational attainment and cochlear implants utility in which lower education attainment is associated with poorer health outcomes.

Education Access and Quality and Cochlear Implantation

Social support through systems and relationships as well as interactions with individuals and community members enhances overall health and decreases mortality, while the lack of social support and connectedness can precipitate adverse health outcomes. In hearing healthcare, the presence of a strong social support system impacts the timing and delivery of hearing healthcare.

Social and Community Context and Cochlear Implantation

Economic stability can influence health outcomes both individually and within a household. Elements of economic stability include employment and income, as well as food and housing security. These elements can impact one's health through various avenues. 

Economic Stability and Cochlear Implantation

The location and quality of housing can influence one's hearing health either positively or negatively. Poor drinking water, mold, lead exposure, pests, environmental exposures, second-hand smoke exposure, and inadequate heating/cooling are housing condition factors that can negatively affect people with hearing difficulties.

Neighborhood and Physical Environment and Cochlear Implantation

To define disparities and advance equity in cochlear implants, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. 

1) Healthcare access/quality

2) Education access/quality

3) Social and community context

4) Economic stability

5) Neighborhood and physical environment


Pepperdine University

-  Despite clear benefits of CI and excellent cost‐effectiveness profile, fewer than 10% of adults meeting audiologic criteria are evaluated for possible implantation.

-  Commonly cited reasons for this low implant rate include a lack of education among patients, audiologists, and physicians, difficulties in maintaining financially viable CI programs and socioeconomic disparities.

Current issues with cochlear implants

Schuh, M., & Bush, M. L. (2021). Defining Disparities in Cochlear Implantation through the Social Determinants of Health. Seminars in hearing, 42(4), 321–330. https://doi.org/10.1055/s-0041-1739282

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