Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

Abstract

Objective Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors. Study Design Retrospective cohort study. Setting Tertiary referral center. Patients Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data. Interventions Diagnostic. Main Outcome Measures Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county. Results Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11–0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009–0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94–0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12–3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A χ 2 test of independence showed no association between receiving CIs and living in medically underserved counties (χ 2 = 2; N = 493; 0.3891; p = 0.53). Conclusions Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.