Editor's Message: Disparities in Healthcare Quality Permeate Audiology, Too

Author: Brian Taylor, Au.D.

The United States is home to stark and persistent disparities in health coverage, chronic health conditions, mental health, and mortality. Many believe these disparities are the result of decades of systematic inequality in American economic, housing, and health care systems. During the 2020 pandemic, these large and persistent gaps in healthcare access and quality have become even more jarring. It is well-established, for example, that non-white, socioeconomically disadvantaged, and non–English-speaking populations shoulder disproportionate COVID-19 burdens.

A Research Letter, published online at JAMA Internal Medicine on December 7, delineates how these disparities impact hearing aid ownership rates in the US. Dr. Nick Reed and other Johns Hopkins researchers analyzed data from the National Health Aging and Trends Study, a longitudinal study of Medicare beneficiaries. Study participants were adults aged 70 and older, who were asked the following survey question: In the last month, have you used a hearing aid or other hearing device?
Figure: Researchers found large disparities in hearing aid ownership across race and gender. Image credit JAMAs.


Results showed those who own and use hearing aids in this group rose from 15.0% in 2011 to 16.9% in 2015 and 18.5% in 2018. However, as shown in the accompanying Figure from the article, there were large disparities in ownership across gender and race. As noted in the article, “fewer Black Americans owned and used hearing aids across time and experienced a smaller overall increase in the proportion who owned and used hearing aids over the 8-year period compared with White Americans (+0.8% vs +4.3%). Black women experienced the smallest growth in hearing aid use across subgroups during the 8-year period. In contrast to White men, who saw a 28.7% increase in hearing aid use.”

The researchers also noted the keen disparity of hearing aid ownership in adults living under the federal poverty level compared to those older individuals well above it, as those living at less than 100% of the federal poverty level saw an overall decline in hearing aid ownership over the eight year period, while those at 2005 or above the poverty level saw an almost five-point improvement in hearing aid ownership during that same time frame.

This study reflects how the current hearing aid delivery system too often caters to the needs and demands of a more affluent, White population. It also provides clinicians and other key stakeholders with an opportunity to contemplate how they can build a more equitable hearing healthcare system that better meets the needs of all older individuals. Given the wide range of research over the past decade that has demonstrated the negative consequences age-related hearing loss has on health-related quality of life outcomes, audiologists can heed the findings of this study by embracing several innovations, including regulatory updates and technological improvements that promote high-quality self-fitting hearing aids sold over-the-counter, supporting third party reimbursement plans that expand the market for hearing aids and endorsing the use of para-professionals that might improve access to services for everyone, especially those of low income and communities of color.    
Reference
Reed NS, Garcia-Morales E, Willink A. Trends in Hearing Aid Ownership Among Older Adults in the United States From 2011 to 2018. JAMA Intern Med. Published online December 07, 2020.