Geographic and Racial Disparities in Infant Hearing Loss.

OBJECTIVE: Approximately 1 to 2 of every 1000 American newborns has hearing loss identified by newborn screening. This study was designed to determine if infant hearing loss is more common in socioeconomically disadvantaged communities. STUDY DESIGN: In this retrospective study, we analyzed electronic medical record data using geostatistical models. SETTING: Infants were residents of Durham County, North Carolina, born in 2 hospitals of the Duke University Health System. This county includes the city of Durham and surrounding suburban and rural communities. SUBJECTS AND METHODS: Subjects were hearing-screened newborns, born between 2005 and 2016, whose residential address was in Durham County, North Carolina. This was a retrospective study using medical record data. We used Bayesian regression models with smoothing of coordinate date to identify both spatial and nonspatial predictors of infant hearing loss. RESULTS: We identified 19,348 infants from Durham County, of whom 675 had failed initial hearing screening and 191 had hearing loss confirmed on follow-up. Hearing loss was significantly associated with minority race (odds ratio [OR], 2.45; 95% confidence interval, 1.97-3.06), as well as lower gestational age and maternal sexually transmitted infections. We identified significant geographic heterogeneity, with a higher probability of hearing loss in poorer urban neighborhoods (local OR range, 0.59-1.39). Neighborhood disadvantage was a significant predictor of hearing loss, as was high local seroprevalence of cytomegalovirus (CMV) among pregnant women. CONCLUSIONS: Urban, low-income neighborhoods have a high prevalence of infant hearing loss compared with more affluent surrounding communities, particularly among minorities. This distribution may be attributable to congenital CMV infection.

Duke Scholars

Author Gabriela Muriel Maradiaga Panayotti Pediatrics, General Pediatrics and Adolescent Health

Author Paul Michael Lantos Medicine, General Internal Medicine

Author Eileen Margolies Raynor Pediatric Otolaryngology

Author Debara Lyn Tucci Head and Neck Surgery & Communication Sciences

Author Kate Hoffman Environmental Sciences and Policy

Author Brenna L Hughes Obstetrics and Gynecology, Maternal Fetal Medicine

Author Geeta Krishna Swamy Obstetrics and Gynecology, Maternal Fetal Medicine