EDITORIAL
Hearing Health Care for All
By René H. Gifford, PhD
R
acial and ethnic disparities in
health care span nearly all medi-
cal subspecialties. Before the
implementation of the Afford-
able Care Act (ACA), the primary un-
derlying factors that drove racial and
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ethnic disparities were health care ac-
cess and insurance coverage (e.g., CDC
MMWR Supplement. 2013;62(3):1).
While the ACA has significantly de-
creased the number of uninsured Amer-
icans and boosted the number of adults
pursuing medical care, the issues of
racial and ethnic disparities in health
care access and utilization remain prev-
alent (Med Care. 2016 Feb;54(2):140;
Ann Fam Med. 2017 Sep;15(5):434;
Issue Brief (Commonw Fund). 2017
May;13:1).
Little has been studied about the rela-
tionship between race and ethnicity and
hearing health care access and utiliza-
tion of hearing technologies. Nieman
and colleagues queried the National
Health and Nutritional Examination Sur-
veys (NHANES) database to document
recent hearing assessment and regular
hearing aid use among older adults (J Ag-
ing Health. 2016 Feb;28(1):68). They
reported that black and Hispanic adults
were significantly less likely than white
adults to use hearing technology. De-
spite having a significantly lower rate of
regular hearing aid use, black adults
were more likely to have had a recent
hearing assessment.
Particularly concerning in relation to
racial and/or ethnic disparity in hearing
technology use is the mounting evi-
dence supporting a correlation between
hearing loss and dementia (Aging Ment
Health. 2014;18:671; The Lancet. 2017;
390: 2673). The risk of developing de-
mentia following hearing loss is signifi-
cantly higher in black and Hispanic
adults compared with white and non-
Hispanic adults (J Am Geriatr Soc.
2017 Aug;65(8):1691). Bainbridge and
Ramachandran found that non-Hispanic
white adults had significantly greater
hearing aid usage rates compared with
both non-Hispanic black and Hispanic
white adults. These hearing aid use
data could not be explained by racial or
ethnic hearing loss prevalence nor by
the geographical demographics of the
study population. Holder and colleagues
reported on the demographic and au-
diologic profile of adults seen for preop-
erative cochlear implant (CI) evaluation
in an urban academic medical center
(Ear Hear. 2014 May-Jun;35(3):289).
They reported that the racial composi-
tion of adults seeking audiologic evalu-
ation for consideration of CI was not
representative of the geographical ar-
eas from which the population was
drawn. Specifically, there was an over-
representation of white and Asian adults
and an underrepresentation of black
adults (they did not describe the ethnic-
ity of preoperative CI patients).
There are multiple reports of racial
and ethnic disparities in access to both
hearing health care and hearing technol-
ogy despite an increased hazard ratio for
developing dementia following hearing
loss in black and Hispanic adults. This
should serve as a warning to us in audiol-
ogy, otolaryngology, and other hearing
health care professions: We are all re-
sponsible for taking part in reducing ra-
cial and ethnic disparities in hearing
health. More than 466 million people
across the world have disabling hearing
loss (WHO, 2018). In the United States,
hearing loss is among the top three most
common chronic conditions, but it is
largely treatable via hearing aids, implant-
able technology, and other assistive de-
vices. We need to unite in our dedication
to provide assessment, treatment, and
prevention of hearing loss for all individu-
als. Closing this gap will require our at-
tention, education, outreach with local
partners, and conscious effort toward
promoting equal access to hearing edu-
cation and technology for people with
hearing loss and those who are at risk.
Who’s ready for the challenge? 
Dr. Gifford is the director
of the Cochlear Implant
Program and the Cochlear
Implant Research Labora-
tory at the Vanderbilt Uni-
versity Medical Center in
Nashville, TN, where she’s
also a professor of hearing
and speech sciences.