CC BY-NC-ND 4.0 · Semin Hear 2021; 42(04): 321-330
DOI: 10.1055/s-0041-1739282
Review Article

Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Marissa Schuh
1   Department of Otolaryngology – Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky
Matthew L. Bush
1   Department of Otolaryngology – Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky
› Author Affiliations
Funding This work was supported by the National Institute of Deafness and Other Communication Disorders (R01DC017770; M.L.B.). The funding organization had no input into the content of this manuscript. M.L.B. is a consultant for MED-EL and Stryker and has received research funding from Advanced Bionics (unrelated to this research).


Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants.

Publication History

Publication Date:
09 December 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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