Socioeconomic and Demographic Trends of Non–English-Speaking Cochlear Implantees: A Large National Database Analysis

Objective To describe national trends in cochlear implantation for non–English-speaking cochlear implant (CI) users. Study Design Retrospective cohort study. Setting US institutions participating in the Epic Cosmos database. Patients Cochlear implantees between 2015 and 2023. Main Outcome Measures Implantation rate, age at implantation, and measures of socioeconomic status. Results A total of 25,883 patients (47% female) received 29,693 cochlear implants; 1,138 (4.4%) spoke a non-English language, with the most common being Spanish (73.4%), Arabic (4.7%), and Chinese (3.0%). Non-English speakers were implanted at lower population-adjusted rates across all age groups compared with English speakers. However, the percentage of non–English-speaking CI recipients (4.6 ± 0.4%) changed little from year to year. A greater proportion of non-English (53.8%; OR, 4.31; 95% CI, 3.86–4.82) and Spanish-speaking (58.5%; OR, 5.23; 95% CI, 4.60–5.95) CI users were children compared with English-speaking (21.2%) cochlear implantees. Compared with English-speaking CI users (79.5%), non–English-speaking CI recipients (93.1%; OR, 3.49; 95% CI, 2.76–4.41) and Spanish-speaking CI recipients (91.8%; OR, 2.88; 95% CI, 2.24–3.71) were more likely to live in urban areas. Both were also more likely to live in ZIP codes with greater social vulnerability as measured by the social vulnerability index ( V = 0.15, V = 0.16). Conclusions There exists evidence of disparities in rates of cochlear implantation based on spoken language at a national level, with rates of cochlear implantation in non-English speakers remaining unchanged over the past 9 years. Non-English CI users are more likely to be implanted as children and are more likely to live in urban areas and ZIP codes with higher SES and SVI compared with English-speaking CI users.