Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

Objective: Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors.Study Design: Retrospective cohort study.Setting: Tertiary referral center.Patients: Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data.Interventions Diagnostic.Main Outcome Measures: Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county.Results: Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11-0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009-0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94-0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12-3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A chi(2) test of independence showed no association between receiving CIs and living in medically underserved counties (chi(2) = 2; N = 493; 0.3891; p = 0.53).Conclusions: Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.