PP1123 - The Follow-up Gap: Racial Disproportionality and Social Determinants of Health in New Jersey’s Hearing Detection and Intervention Program

Abstract:
Early Hearing Detection and Intervention (EHDI) programs have been implemented to identify the 2-3 babies per 1,000 born yearly with hearing loss. Nearly all babies receive hearing screenings at birth; however, many still need recommended audiological follow-up and are lost to follow-up (LTF). This study examines how social determinants of health explain racial/ethnic differences in follow-up from NJ’s EHDI program. The study included all babies born in two years who needed additional hearing healthcare after hospital discharge. Bivariate analysis – identify relationships between race/ethnicity, family-level SDOH, and neighborhood context, including both neighborhood vulnerability and structural racism.

Summary:
Background
Early Hearing Detection and Intervention (EHDI) programs have been implemented to identify the 2-3 babies per 1,000 born yearly with hearing loss. Nearly all babies receive hearing screenings at birth; however, many do not receive recommended audiological follow-up and are lost to follow-up (LTF). This study examines the degree to which social determinants of health explain racial/ethnic differences in follow-up from NJ’s EHDI program.

Method
Data were obtained from New Jersey’s Department of Health. The study included all babies born in a two-year period who needed additional hearing healthcare after hospital discharge. Bivariate analysis explored relationships between race/ethnicity and SDOH. Disparity ratios (DRs) compared LTF rates between Black and White and Hispanic and White babies while considering SDOH. Logistic regression determined the degree to which SDOH could explain racial disparities.

Results
There were significant differences between racial/ethnic groups and all SDOH. DRs indicated that Black babies were more likely than White babies to be LTF (DR: 1.19-1.80), and Hispanic babies were less likely than White babies to be LTF regardless of SDOH (DR: 0.96-0.49). Logistic regression illustrated that, when controlling for all SDOH, the odds of being LTF dropped between Black and White families and increased between White and Hispanic families.

Conclusion
SDOH can only partially explain differences in follow-up rates between racial/ethnic groups. Structural racism may play a role in differences between Black and White families. The “Hispanic paradox” was observed in our findings and should be explored further to develop solutions to close racial/ethnic gaps.

Brief Summary of Clinical Takeaways:
Existing methods for reaching families who need follow-up hearing healthcare has not been effective for Black families, a historically underserved population. In addition to Black families, younger mothers and those without a college degree should be considered for tailored interventions to improve follow-up rates

Assumptions
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