Temporal Trends in Early Pediatric Cochlear Implantations in California from 2018 to 2020.

Objective: To characterize the demographics of children receiving cochlear implantations, identify factors associated with delayed implantations, and trend these factors over time.

Design: Retrospective cross-sectional study.

Setting: Healthcare Cost and Utilization Project California State Ambulatory Surgery Database for calendar years 2018-2020.

Patients: Children 5 years or younger undergoing cochlear implantation.

Interventions: Cochlear implantation.

Main Outcomes Measures: The population-controlled number of cochlear implantations was calculated and stratified by race and insurance. Early implantation was defined as implantation at age 2 years or younger. A mixed-effects logistic regression model was generated to identify factors associated with early implantation and how that association changed from 2018 to 2020.

Results: The final cohort included 467 children. The number of implantations increased from 141 to 175 implants from 2018 to 2020 (24.1% increase); 229 (49.0%) children were implanted at 2 years or younger. Medicaid insurance was associated with decreased odds of early implantation (odds ratio, 0.18 [95% confidence interval, 0.15-0.23], p < 0.001); this association with Medicaid insurance was significant when stratified across all racial groups. The percentage of children with Medicaid who were implanted at 2 years or younger increased from 20.9 to 62.0% from 2018 to 2020.

Conclusions And Relevance: Among children in California, socioeconomic factors, in particular public insurance, are correlated with age of cochlear implantation. These disparities improved significantly from 2018 to 2020. Further investigation into changes and initiatives in California during this time frame may aid in directing national efforts to improve pediatric cochlear implantation access.