PP310 - Disparities in Hearing Aid Use: Price Responsiveness among Elderly with Hearing Impairment

Only 10% to 30% of hearing-impaired older adults use hearing aids (HAs) with cost cited as a significant adoption barrier. Recently passed FDA regulations attempted to expand the availability of HAs by allowing lower cost devices to enter the market. However, if increasing HA use was the impetus for this legislation, it is unclear if a marginal reduction in device cost will significantly increase HA use among elderly Americans. This study explores the role of race, ethnicity, income, residential context, and historic variation in HA price and HA usage among a nationally representative cohort of elderly adults with hearing loss.

Summary:

Rationale/Objective: Only 10% to 30% of hearing-impaired older adults use hearing aids (HAs) or other amplification devices and studies have cited cost as a significant barrier to adoption. In fact, recently passed Food and Drug Administration (FDA) regulations attempted to expand the availability of HAs and other devices by allowing lower cost devices to enter the market. However, if increasing HA use among those with hearing impairment was the impetus for this legislation, it is unclear if a marginal reduction in device cost will significantly increase hearing aid use among elderly Americans. The objective of this study was to explore the role of race, ethnicity, income, residential context, and historic variation in HA price and HA usage to determine if these factors influence hearing aid use among a nationally representative cohort of elderly adults with hearing impairment.

Methods: Multilevel logistic regression models evaluated data from the 2012 through 2017 Medical Expenditure Panel Survey (MEPS) to 1) compare historic HA use between subgroups, 2) test for differential responsiveness to price changes between racial and ethnic groups, and 3) assess the relative role of demographic characteristics, device cost, income, family size, marital status, region of residence, race/ethnicity, sex, and physical/mental health status on HA use. Survey data collected from dispensing professionals on the price of receiver-in-the-canal (RIC) hearing aids by The Hearing Review for average cost of economy hearing aids was used to account for annual variation in HA prices.

Results: Between 2012 and 2017, the price of economy HAs decreased by 5%. During this same period, HA use among Whites and Hispanics with hearing impairment increased by 30% and 20% respectively, but usage among Blacks increased by less than 10%. After controlling for age, income, family size, and price, estimates show that Blacks were two times less likely than Whites to use a HA. Age, female sex, and physical health status were highly correlated with the likelihood of HA among all racial and ethnic groups, but household income and price were only significant for Whites who showed that a 1% increase in income was correlated with a 10% increase in the likelihood of HA use. Calculation of subgroup participation elasticities showed that, when the price of HAs dropped by 1%, the likelihood of HA use by Whites increased by 14.2%, Hispanics increased by 13.2%, and Other races increased by 14.8%, but only 2.8% among Blacks.

Conclusion: Results suggest that cost is not the primary barrier to HA utilization among minoritized racial and ethnic groups. Therefore, additional analyses are needed to evaluate the role of social, cultural, and environmental influences on HA utilization and determine if inequities within the healthcare system can explain these disparities among non-White elderly individuals.