LM107 - The Impact of Socioeconomic Factors and Inequalities on Hearing Health Care

Abstract:
In the United States, socioeconomic factors lead to disparities in and access to audiological services. Costs of care and insurance coverage are notably impactful. Proximity to care is particularly relevant for certain subsets of patients and can result in delayed initiation of care. Furthermore, hearing loss affects employment which, in turn, affects income. Adults with hearing loss have, on average, 25% lower wages, a higher rate of unemployment and under-employment, and leave the workforce earlier. It is imperative that audiologists combat these inequities by accessing community resources, supporting charitable organizations, and embracing alternative models of care.

Summary:
Socioeconomic disparities affect all healthcare in the United States, including that provided by audiologists. The barriers imposed by income as well as geographic, racial, ethnic, and cultural factors are prevalent and can be strongly impactful upon access and outcomes. Many factors including high costs, imbalanced healthcare delivery models, and proximity to care make audiological and other healthcare services difficult to access and utilize.

Income inequality shades our national healthcare system. Large-scale studies have shown that decreased financial means can affect prevalence of chronic health conditions and life expectancy. Income disparities are particularly prevalent and more impactful in Southern US states, in Black and Hispanic communities, in rural areas, and for mental/psychiatric healthcare.

These disparities strongly impact Audiology. Costs for care and lack of insurance coverage have been found to be among the top barriers to treating hearing loss. Studies found that the most likely candidates for hearing aid adoption were older, non-Hispanic, white, educated and wealthy whereas those at or below $25k annual income were far less likely to treat their hearing loss and were more concerned about meeting their basic needs (food, shelter etc.).

A person’s geographic location in proximity to major cities (and, typically, healthcare centers) can greatly impact access to quality healthcare and rurality is a critical determinant of access to audiologic services. Lack of local providers and distance to care locations is the largest factor. Rural patients access hearing care on average eight years later than those living in urban areas. Rural hearing aid users are also less like to achieve post-secondary education and are often insured through Medicaid. 60% of all rural patients indicated that their hearing loss affected job performance. One study found that urban vs. rural residence was a particularly large factor in hearing aid adoption for Black and Hispanic adults.

In addition to low income affecting the identification and treatment of adults with hearing loss, having hearing loss further impedes economic potential for adults by affecting employment and earnings. In a large literature review, 86% of studies showed evidence of a higher rate of unemployment and under-employment in adults with hearing loss. Hearing impaired employees tend to hold jobs in lower occupational classes (e.g. manual labor/”blue collar”). These individuals have much difficulty hearing and understanding speech in background noise, and experience high levels of listening fatigue. Wages of hearing impaired versus normal-hearing employees were on average 25% lower.

Professional issues such as poor reimbursement and shortage of providers in rural areas impact the availability and affordability of hearing healthcare. How can audiologists this population and still afford the operation of their business? Our profession needs to think outside the box. In the interests of public health and well being, it is necessary for audiology to make strides toward business models friendly to lower-income patients. Alternatives to traditional care, access to mobile and remote services and charitable efforts are ways to help all persons with hearing loss so that their financial status and/or address does not impede their opportunities for success.