Author(s)
Lauren Mueller
Dean Adkins
Preethi Tumati
Marie-Ange Munyemana
Dorina Kallogjeri
Judith E. Lieu
Affiliation(s)
Washington University School of Medicine;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to quantify the impact of social determinants of health (SDH), defined as environmental conditions affecting health, functioning, and quality of life, on long term language, academic, and quality of life (QoL) outcomes in pediatric cochlear (CI) implant recipients. These outcomes remain highly variable, but this variability has yet to be quantitatively synthesized in literature.
Objectives: 1) To determine the impact of SDH on language, academic, and QoL outcomes in pediatric CI recipients; and 2) to compare the impact with known variables that affect pediatric CI outcomes, such as age of CI implantation and duration of CI implantation.
Study Design: Systematic review and meta-analysis.
Methods: Four databases were searched for studies examining outcomes of pediatric CI according to SDH. Abstracts were screened for inclusion, and two reviewers performed full text review and data extraction. Random effects meta-analysis was used.
Results: From 4,438 abstracts, 56 articles were included in a systematic review and meta-analysis. Language outcomes were reported in 37 studies (3,957 children). Improved language abilities were associated with higher parental education (n=7 studies, 631 children); (r_pooled=.302; 95%CI, .223 to.380), higher socioeconomic status (n=7 studies, 656 children); (r_pooled= .191; 95%CI, .091 to .292), and younger age of CI implantation (n=9 studies, 839 children); (r_pooled= -.242; 95%CI, -.386 to -.098). Academic outcomes were reported in 6 studies (732 children). Higher reading scores were associated with increased years in mainstream school education (n=3 studies; 406 children) (r_pooled= .283; 95%CI, .188 to .378). QoL outcomes were reported in 15 studies (1,220 children). Improved self-image and autonomy were associated with increased parental involvement (n=2 studies; 211 children) (r_pooled= .276; 95%CI, .182 to .371).
Conclusions: SDH have a small to medium correlation on the variability of pediatric CI language, reading, and QoL outcomes. The environmental and societal context of pediatric CI recipients' living and learning environment affects long term health, functioning, and QoL.