Barriers to Hearing Health Care in the Northern US: A Comparison of Rural and Urban Minnesotans

OBJECTIVE: To assess and compare rural versus urban Minnesotans experiences, perspectives, and awareness of hearing health care. STUDY DESIGN: Cross-sectional study. SETTING: Community-based screening at Driven to Discover Research Facility in Bemidji and St. Paul, MN. PATIENTS: Adults ≥18 years. INTERVENTIONS: In-person survey, otoscopy, and audiometric screening at 25 dB across four frequencies. MAIN OUTCOME MEASURES: Descriptive analysis of sociodemographics, awareness of hearing loss and health care, and Brief Health Literacy Screening (BHLS). Hearing loss (HL) was defined as failing at least 1 frequency in 1 ear. RESULTS: There were 77 rural and 212 urban participants, mean age 57.9 years rural versus 47.4 years urban (P<0.05). Overall, 58.8% female, 88.5% white, 93.7% insured. Health literacy was adequate in both groups (mean rural BHLS 13.5 [95% CI: 13.2-13.8], urban 14.2 [95% CI: 14.0-14.4], P<0.05). Rural residents were more likely to have subjective HL (57.1% vs. 32.1%, P<0.05) and audiometric HL (69.9% vs. 42.0%, P<0.05). Rural and urban participants reported similar rates in challenges with access to hearing health care (27.3% vs. 24.1%, P=0.58). Both groups had low rates of hearing testing within 5 years (33.8% vs. 30.2%, P=0.53). Few participants from either group were aware of normal hearing levels (15.6%), discussed hearing testing with their primary care provider (PCP) (9.5%), or had awareness of Minnesota Medicaid coverage of hearing services (35.6%). CONCLUSIONS: Urban and rural residents in the Upper Midwest with good health literacy have poor awareness of hearing health and available hearing health care. Both would benefit from public health initiatives to educate PCPs and increase awareness of state benefits.