Health service utilization in children with permanent hearing loss: a nested case control study

Objective — Permanent hearing loss (PHL) is accompanied by disabilities in approximately 40% of children but little is known about health service use. The objective was to compare health service utilization and chronic complex conditions (CCCs) in children with PHL with matched controls.

Study design — Nested case-control study: Data from children with PHL were linked to population-based health administrative data between January 1, 1991 and December 31, 2013, before and after implementation of the Early Hearing Detection and Intervention program in 2002.

Setting — Tertiary care pediatric hospital.

Patients — Population-based cohort of 591 children with PHL identified from a clinical database and 2951 matched controls.

Main outcome measures — CCCs and health services encounters unrelated to hearing within 2 years postbirth. In multivariable models, independent variables were number of CCCs and era of PHL diagnosis.

Results — PHL cases had more CCCs (39.9%) than matched controls (8.1%; P<.001) and made greater use of health services: by 2 years postbirth, this included more emergency (IRR 1.25, 95% CI: 1.08-1.46) and outpatient (IRR 1.44, 95% CI: 1.37-1.53) visits and longer inpatient hospitalization (IRR 1.62, 95% CI: 1.50-1.76) than controls. The association between PHL status and health services utilization remained significant after controlling for CCCs and era of PHL diagnosis.

Conclusions — Children with PHL have higher health services use in the first 2 years of life, and are more affected by CCCs. Early identification of these children can optimize outcomes and help plan within the health system.