Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and “as the crow flies” distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands.

1.
Arlinger S. Negative consequences of uncorrected hearing loss--a review. Int J Audiol. 2003;42(Suppl 2):2S17–20.
2.
Brems C, Johnson ME, Warner TD, Roberts LW. Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care. 2006;20(2):105–18.
3.
Crowson MG, Chen JM, Tucci D. Provincial variation of cochlear implantation surgical volumes and cost in Canada. Otolaryngol Head Neck Surg. 2017;156(1):137–43.
4.
Cullington H, Kitterick P, Weal M, Margol-Gromada M. Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial. BMJ Open. 2018;8(4):e019640.
5.
Cumpston E, Chen P. Implantable Hearing Devices; 2023.
6.
Dawes P, Emsley R, Cruickshanks KJ, Moore DR, Fortnum H, Edmondson-Jones M, et al. Hearing loss and cognition: the role of hearing AIDS, social isolation and depression. PLoS One. 2015;10(3):e0119616.
7.
Elpers J, Lester C, Shinn JB, Bush ML. Rural family perspectives and experiences with early infant hearing detection and intervention: a qualitative study. J Community Health. 2016;41(2):226–33.
8.
Feder KP, Michaud D, McNamee J, Fitzpatrick E, Ramage-Morin P, Beauregard Y. Prevalence of hearing loss among a representative sample of Canadian children and adolescents, 3 to 19 Years of age. Ear Hear. 2017;38(1):7–20.
9.
Fitzpatrick EM, Brewster L. Adult cochlear implantation in Canada: results of a survey. Can J Speech Lang Pathol Audiol. 2010;34(4):290–96.
10.
Fitzpatrick EM, Ham J, Whittingham J. Pediatric cochlear implantation. Ear Hear. 2015;36(6):688–94.
11.
Hagr A. BAHA: bone-anchored hearing aid. Int J Health Sci. 2007;1(2):265–76.
12.
Health Quality Ontario. Bilateral cochlear implantation: a health technology assessment. Ont Health Technol Assess Ser. 2018;18(6):1–139.
13.
Health Quality Ontario. Geographic location methods review: summary report; 2019.
14.
Hixon B, Chan S, Adkins M, Shinn JB, Bush ML. Timing and impact of hearing healthcare in adult cochlear implant recipients: a rural-urban comparison. Otol Neurotol. 2016;37(9):1320–4.
15.
Kralj B. Measuring “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ont Med Rev. 2000;67:33–52.
16.
Krogmann RJ, Al Khalili Y. Cochlear Implants. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
17.
Matkin ND, Wilcox AM. Considerations in the education of children with hearing loss. Pediatr Clin North Am. 1999;46(1):143–52.
18.
McSweeny C, Cushing SL, Campos JL, Papsin BC, Gordon KA. Functional consequences of poor binaural hearing in development: evidence from children with unilateral hearing loss and children receiving bilateral cochlear implants. Trends Hear. 2021;25:23312165211051215.
19.
Nassiri AM, Yawn RJ, Gifford RH, Holder JT, Stimson CJ, Eavey RD, et al. Same-day patient consultation and cochlear implantation: innovations in patient-centered health care delivery. Otol Neurotol. 2020;41(2):e223–6.
20.
Nassiri AM, Holcomb MA, Perkins EL, Bucker AL, Prentiss SM, Welch CM, et al. Catchment profile of large cochlear implant centers in the United States. Otolaryngol Head Neck Surg. 2022;167(3):545–51.
21.
Shayman CS, Ha Y-M, Raz Y, Hullar TE. Geographic disparities in US veterans’ access to cochlear implant care within the veterans health administration system. JAMA Otolaryngol Head Neck Surg. 2019;145(10):889–96.
22.
Statistics Canada. Canadians with a hearing disability. Ottawa; 2019.
23.
Statistics Canada. Population growth in Canada’s rural areas, 2016 to 2021. Ottawa; 2022.
24.
World Health Organization. WHO global estimates on prevalence of hearing loss. Geneva: WHO; 2017.
25.
World Health Organization. Deafness and hearing loss; 2023.
26.
Yeo BSY, Song HJJMD, Toh EMS, Ng LS, Ho CSH, Ho R, et al. Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia. JAMA Neurol. 2023;80(2):134.
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