老年双侧感音神经性听力损失患者在听力学和人工耳蜗护理中的可及性与流失。

文献信息

中文摘要

目的： 量化美国65岁及以上双侧感音神经性听力损失（SNHL）成人通过听力护理路径的进展，并描述地理和社区背景下的差异。
研究设计： 横断面研究。
地点： Epic Cosmos数据库，2021年1月1日至2024年12月31日。
患者： 使用国际疾病分类第十版代码识别的65岁及以上双侧SNHL成人。
主要结局和测量指标： 计算阶段特异性未调整比值比及95%置信区间，用于评估听力学评估、人工耳蜗评估和人工耳蜗植入的进展。统计显著性定义为P < 0.05，鉴于大样本量，P < 0.001被视为强信号。
结果： 在1,461,489名双侧SNHL老年人中，746,118名（51.1%）接受了听力学评估；不到2%接受了人工耳蜗候选资格评估，而在接受人工耳蜗植入评估者中约64%进展至手术。观察到显著的阶段特异性流失。85岁及以上成人听力学可及性比值比较低，候选资格评估比值比较高，人工耳蜗植入比值比较低。黑人和亚裔患者候选资格评估比值比较低。女性接受候选资格评估的可能性较低，但一旦评估候选资格后接受植入的可能性较高。居住地距离人工耳蜗中心较远的患者和农村地区患者，候选资格评估和人工耳蜗植入的比值比均较高，这一反直觉发现可能反映了克服距离障碍患者中的选择效应，而非地理可及性改善。
结论： 在这个全国队列中，人工耳蜗护理路径上的差异与距离导致的听力学可及性关系较小，而与人工耳蜗候选资格评估阶段的流失关系较大。候选资格转诊和评估是改善老年人听力护理公平性的关键且可能可修改的瓶颈。

英文摘要

OBJECTIVE: To quantify progression through the hearing care pathway among US adults aged ≥65 years with bilateral sensorineural hearing loss (SNHL) and describe variation across geographic and community contexts.
STUDY DESIGN: Cross-sectional study.
SETTING: Epic Cosmos Database, January 1, 2021, through December 31, 2024.
PATIENTS: Adults aged ≥65 years with bilateral SNHL identified using International Classification of Diseases, Tenth Revision codes.
MAIN OUTCOMES AND MEASURES: Stage-specific unadjusted odds ratios with 95% confidence intervals were calculated for progression across audiology evaluation, cochlear implant evaluation, and cochlear implantation. Statistical significance was defined as P < 0.05, with P < 0.001 considered a strong signal given the large sample size.
RESULTS: Among 1,461,489 older adults with bilateral SNHL, 746,118 (51.1%) underwent audiology evaluation; fewer than 2% received cochlear implant candidacy evaluation, while approximately 64% of those evaluated for cochlear implantation proceeded to surgery. Marked stage-specific attrition was observed. Adults aged 85 years or older had lower odds of audiology access, higher odds of candidacy evaluation, and lower odds of cochlear implantation. Black and Asian patients had lower odds of candidacy evaluation. Women were less likely to undergo candidacy evaluation but more likely to receive implantation once evaluated for candidacy. Patients living farther from a cochlear implant center and those in rural areas had higher odds of both candidacy evaluation and cochlear implantation, a counterintuitive finding that likely reflects a selection effect among patients who overcome distance barriers rather than improved geographic access.
CONCLUSIONS: In this national cohort, disparities along the cochlear implant care pathway were associated less with audiologic access due to distance and more with attrition at cochlear implant candidacy assessment. Candidacy referral and evaluation represent a critical, potentially modifiable bottleneck for improving equity in hearing care among older adults.