We found individuals who were hard-of-hearing as compared to those not hard-of-hearing to be significantly more likely to report experiencing difficulties and delays in accessing care. The disparity in access persisted even after controlling for several variables known to influence health care access and satisfaction. However, the two groups did not differ on satisfaction with access to care.
Our findings differ from prior studies that found lower satisfaction with access to care in populations with disabilities [24
]. However, our study design allowed us to include variables not included in these prior studies that are known to have an important effect on satisfaction with access to care. In particular, we adjusted for depression, which has a significant negative effect on satisfaction with access to care [47
]. Our unadjusted results did reveal a statistically significant difference in satisfaction with access to care between groups (). Alternatively, differences in sample populations also may account for our varying results. In particular, nearly one-third of the responses to the Medicare Care Beneficiary Survey were completed by proxies, allowing for representation from those with more profound disabilities such as severe hearing loss [24
]. The focus in our sample was on those hard-of-hearing, but able to complete their own telephone surveys. Alternatively, our sample was predominantly well educated and white. Therefore, some of our differences may be explained by the different socio-demographic factors of our sample as compared to samples drawn from nationally representative surveys.
Our findings of similar satisfaction with access to care despite significant differences in perceived difficulties and delays in accessing care adds to the literature suggesting that detailed questions about barriers to accessing care may be more helpful than a summary satisfaction measure. Discrepancies between overall high satisfaction scores and reported problems with care have been reported after hospitalization [48
] leading to a call for specificity in patient feedback when identifying problems for intervention [50
Our findings should be considered in light of several limitations. Our sample represents individuals who were attending Wisconsin high schools in the 1950s and therefore is limited in geographical and racial/ethnic diversity. Our classification of individuals as hard-of-hearing is based on self-report and thus may be subject to misclassification bias. However, the accuracy of self-reported hearing loss has been validated in older adult populations [51
]. Next, the proportion of individuals with hearing loss in our sample was substantially lower than that estimated in an age matched older adult population. This discrepancy is partially explained by the relatively high education bias and income in our sample, as hearing loss is inversely associated with these factors [3
]. Also, by using data from respondents to a combined telephone and mail survey, our findings excluded hard-of-hearing individuals who could not use a telephone because of their hearing loss, did not feel comfortable answering questions on the telephone [52
], or did not own a phone [54
]. By excluding these individuals it is likely that analyses of the Wisconsin Longitudinal Study data underestimate actual disparities in access to care. Further research in this area incorporating methods other than telephone surveys is needed.
In conclusion, our findings suggest that adults who are hard-of-hearing are more likely to experience difficulties and delays in accessing health care as compared to those who are not hard-of-hearing. Further investigation is needed into why hard-of-hearing individuals report more difficulties and delays in accessing care. This research could examine the age of onset of hearing difficulty in relation to differences in health care behavior, and incorporate survey methods other than telephone surveys. Our findings are concerning for multiple reasons. First, with the increasing prevalence of hearing loss [23
], access to care issues will be heightened for more of the population. Furthermore, as there is significant co-morbidity associated with hearing-loss, poor access [55
] compounded by known communication difficulties in the physician-patient relationship [9
] poses serious health risks. Clinicians should pay particular attention to assessing barriers in access to care for hard-of-hearing individuals. Resources should be made available to proactively address the access to care issues for those who are hard-of-hearing and to educate providers about the specific needs of this population.