Infant Hearing Screening in the US, 2001: Results from the ECLS-B Study

Infant Hearing Screening Infant Hearing Screening in the US, 2001: in the US, 2001:

Results from the ECLS-B Study Results from the ECLS-B StudyMay S. Chiu, B.S.May S. Chiu, B.S.

Magdaliz Gorritz, B.S.Magdaliz Gorritz, B.S.Howard J. Hoffman, M.A.Howard J. Hoffman, M.A.

National Institute on Deafness and Other Communication Disorders (NIDCD)National Institute on Deafness and Other Communication Disorders (NIDCD) National Institutes of Health (NIH)National Institutes of Health (NIH)

Bethesda, Maryland 20892Bethesda, Maryland 20892

Faculty Disclosure InformationFaculty Disclosure Information

In the past 12 months, I have not had a significantIn the past 12 months, I have not had a significantfinancial interest or other relationship with thefinancial interest or other relationship with the

manufacturer(s) of the product(s) or provider(s) ofmanufacturer(s) of the product(s) or provider(s) ofthe service(s) that will be discussed in mythe service(s) that will be discussed in my

presentation.presentation.

This presentation will (not) include discussion ofThis presentation will (not) include discussion ofpharmaceuticals or devices that have not beenpharmaceuticals or devices that have not been

approved by the FDA or if you will be discussingapproved by the FDA or if you will be discussingunapproved or “off-label” uses of pharmaceuticals orunapproved or “off-label” uses of pharmaceuticals or

devices.devices.

Sponsoring AgenciesSponsoring Agencies

U.S. Department of Education,U.S. Department of Education, National Center for Education StatisticsNational Center for Education Statistics

U.S. Department of Health and Human Services U.S. Department of Health and Human Services National Center for Health Statistics, CDCNational Center for Health Statistics, CDC National Institute of Child Health and Human DevelopmentNational Institute of Child Health and Human Development National Institute on Deafness and Other Communication DisordersNational Institute on Deafness and Other Communication Disorders Health Resources and Services Administration Health Resources and Services Administration --

Maternal and Child Health BureauMaternal and Child Health Bureau Office of Minority HealthOffice of Minority Health

Other Federal agenciesOther Federal agencies

Early Childhood Longitudinal StudyEarly Childhood Longitudinal Study

Multi-dimensional study focusing on the Multi-dimensional study focusing on the early home and educational experiences early home and educational experiences of children through first 6 years of lifeof children through first 6 years of life

Birth cohort (ECLS-B), 2001Birth cohort (ECLS-B), 2001

Nationally representative sampleNationally representative sample

ECLS Conceptual ModelECLS Conceptual Model

Care and Education

Neighborhood and Community

School

Family

Child

Study Design of ECLS-BStudy Design of ECLS-B N=10,688N=10,688

OversamplesOversamples MinoritiesMinorities Very low birth weight (<1500 g)Very low birth weight (<1500 g) Moderately low birth weight (1500 - 2499 g)Moderately low birth weight (1500 - 2499 g) Twins Twins

Household surveys conducted by trained personnel at Household surveys conducted by trained personnel at 9 months9 months

Bayley exams (modified for ECLS-B) conducted at 9 Bayley exams (modified for ECLS-B) conducted at 9 months and 2 yearsmonths and 2 years

Early Childhood Longitudinal StudyEarly Childhood Longitudinal Study

For more information visit: http://nces.ed.gov/ecls/index.asp

EHDI vs. ECLS-B, 2001EHDI vs. ECLS-B, 2001

EHDIEHDI Annual data collectionAnnual data collection

State-level outcome dataState-level outcome data Hearing screeningHearing screening Hearing loss DxHearing loss Dx Enrollment in intervention Enrollment in intervention

program program

Global screening rate Global screening rate ≈≈ 65% before discharge65% before discharge

ECLS-BECLS-B One year (2001) births onlyOne year (2001) births only

Person-level outcome dataPerson-level outcome data Hearing screeningHearing screening Hearing loss DxHearing loss Dx Receiving hearing servicesReceiving hearing services

Global screening rate Global screening rate ≈≈ 70% before discharge70% before discharge

78% by 9 months78% by 9 months

Why ECLS-B?Why ECLS-B?

Child

Health

•Physical

•Activity

•Nutrition

Physical growth

Cognitive

Language

Motor skills

Parent

Demographics

Health

•Physical

•Mental

•Nutrition

Marital/partner relationship

Family organization

Child care

Care/EducationProvider

Background and experience

Learning environment

Teaching practices

School/Teacher

School demographics

Children’s development

School programs

Educational goals and objectives

Additional information is available, for example:

ECLS-BECLS-B

Analysis of Variables Analysis of Variables Related to Hearing Related to Hearing

ScreeningScreening

Demographics Demographics (n=10,531)(n=10,531)

RegionRegion % Screened% Screened OROR 95% CI95% CI

NortheastNortheast 76%76% 1.001.00 ——

MidwestMidwest 75%75% 0.920.92 0.55 – 1.530.55 – 1.53

WestWest 70%70% 0.700.70 0.46 – 1.080.46 – 1.08

SouthSouth 86%86% 1.871.87 1.19 – 2.951.19 – 2.95

Source: 9-month composite variables

Demographics (cont’d)Demographics (cont’d)

County Pop. SizeCounty Pop. Size % Screened% Screened OROR 95% CI95% CI

< 100,000< 100,000 82%82% 1.001.00 ——

100,000-250,000100,000-250,000 76%76% 0.720.72 0.47 – 1.110.47 – 1.11

250,001-500,000250,001-500,000 85%85% 1.301.30 0.83 – 2.040.83 – 2.04

500,001-1,000,000500,001-1,000,000 76%76% 0.710.71 0.46 – 1.110.46 – 1.11

1,000,000+1,000,000+ 72%72% 0.400.40 0.40 – 0.780.40 – 0.78

Source: birth certificate data


GenderGender % Screened% Screened OROR 95% CI95% CI

MaleMale 78%78% 1.031.03 0.89 – 1.190.89 – 1.19

FemaleFemale 78%78% 1.001.00 ——



RaceRace % Screened% Screened OROR 95% CI95% CI

Non-Hispanic Non-Hispanic WhiteWhite 79%79% 1.001.00 ——

Non-Hispanic Non-Hispanic BlackBlack 82%82% 1.201.20 0.94 – 1.540.94 – 1.54

Hispanic/LatinoHispanic/Latino 73%73% 0.710.71 0.57 – 0.900.57 – 0.90

OtherOther 77%77% 0.870.87 0.68 – 1.110.68 – 1.11


Family InformationFamily Information

Household IncomeHousehold Income % Screened% Screened OROR 95% CI95% CI

≤≤$15,000$15,000 78%78% 1.001.00 ——

$15,001-$30,000$15,001-$30,000 77%77% 0.910.91 0.77 – 1.070.77 – 1.07

$30,001-$50,000$30,001-$50,000 76%76% 0.870.87 0.72 – 1.050.72 – 1.05

$50,001-$100,000$50,001-$100,000 79%79% 1.041.04 0.85 – 1.280.85 – 1.28

>$100,000>$100,000 80%80% 1.091.09 0.79 – 1.490.79 – 1.49

Source: 9-month parent CAPI instrument and parent questionnaire

Family Information (cont’d)Family Information (cont’d)

Mother’s Mother’s EducationEducation % Screened% Screened OROR 95% CI95% CI

College graduateCollege graduate 84%84% 1.001.00 ——

Some collegeSome college 79%79% 0.740.74 0.58 – 0.960.58 – 0.96

High school High school diplomadiploma 76%76% 0.620.62 0.47 – 0.820.47 – 0.82

No high school No high school diplomadiploma 75%75% 0.600.60 0.45 – 0.800.45 – 0.80


Other Significant FactorsOther Significant Factors

Mother Medical Mother Medical Risk FactorRisk Factor % Screened% Screened OROR 95% CI95% CI

Pre-EclampsiaPre-Eclampsia

YesYes 92%92% 3.403.40 1.50 – 7.741.50 – 7.74

NoNo 78%78% 1.001.00 ——

Uterine bleedingUterine bleeding

YesYes 96%96% 7.677.67 3.06 – 19.203.06 – 19.20

NoNo 78%78% 1.001.00 ——

Source: Birth certificate data

Infant InformationInfant Information

Birth WeightBirth Weight % Screened% Screened OROR 95% CI95% CI

Normal Normal ((≥ ≥ 2500 g)2500 g) 77%77% 1.001.00 ——

Moderately low Moderately low (1500 – 2499 g)(1500 – 2499 g) 84%84% 1.511.51 1.27 – 1.781.27 – 1.78

Very low Very low (< 1500 g) (< 1500 g) 94%94% 4.974.97 3.55 – 6.973.55 – 6.97


Infant Information (cont’d)Infant Information (cont’d)

Gestational AgeGestational Age % Screened% Screened OROR 95% CI95% CI

≤≤20 – 27 wks20 – 27 wks 97%97% 8.168.16 4.46 – 14.944.46 – 14.94

28 – 30 wks28 – 30 wks 88%88% 2.202.20 0.98 – 4.940.98 – 4.94

31 – 33 wks31 – 33 wks 85%85% 1.681.68 1.04 – 2.711.04 – 2.71

34 – 36 wks34 – 36 wks 81%81% 1.221.22 1.02 – 1.471.02 – 1.47

Term: 37+ wksTerm: 37+ wks 77%77% 1.001.00 ——

Source: Birth certificate data

Infant Information (cont’d)Infant Information (cont’d)

Child ConditionChild Condition % Screened% Screened OROR 95% CI95% CI

Failure to thrive DxFailure to thrive Dx

YesYes 93%93% 4.074.07 1.33 – 12.421.33 – 12.42

NoNo 78%78% 1.001.00 ——

Home apnea Home apnea monitor prescribedmonitor prescribed

YesYes 90%90% 2.542.54 1.51 – 4.291.51 – 4.29

NoNo 78%78% 1.001.00 ——


Infants Receiving Hearing ServicesInfants Receiving Hearing Services at 9 Months at 9 Months (n=105) (n=105) ―― Univariate AssociationsUnivariate Associations

CharacteristicCharacteristic OROR 95% CI95% CI

TwinTwin 2.72.7 1.5 – 4.91.5 – 4.9

Very low birth weightVery low birth weight 24.224.2 13.1 – 44.613.1 – 44.6

Moderately low birth weightModerately low birth weight 3.83.8 1.9 – 7.51.9 – 7.5

Gestational age: <=27wksGestational age: <=27wks 27.727.7 13.4 – 57.213.4 – 57.2

Gestational age: 28-30 wks Gestational age: 28-30 wks 10.210.2 5.1 – 20.35.1 – 20.3

Longer stay in hospitalLonger stay in hospital 14.714.7 6.7 – 32.26.7 – 32.2

Difficulty seeingDifficulty seeing 71.871.8 27.1 – 190.527.1 – 190.5

Cleft lipCleft lip 66.366.3 16.3 – 268.916.3 – 268.9

Heart defectHeart defect 5.45.4 2.8 – 10.32.8 – 10.3

Problem using handsProblem using hands 74.874.8 26.8 – 209.026.8 – 209.0

Other ServicesOther Services OROR 95% CI95% CI

Vision servicesVision services 8.88.8 3.7 – 21.03.7 – 21.0

Physical therapyPhysical therapy 4.84.8 2.1 – 10.82.1 – 10.8

Social work servicesSocial work services 4.04.0 2.0 – 7.92.0 – 7.9

Home servicesHome services 7.07.0 3.2 – 15.33.2 – 15.3

Parent support/trainingParent support/training 3.73.7 1.8 – 7.61.8 – 7.6


Infants Receiving Hearing Services Infants Receiving Hearing Services at 9 Months (n=105)at 9 Months (n=105)

Summary of FindingsSummary of Findings

Lower screening rate for Hispanic/Latino infants Lower screening rate for Hispanic/Latino infants

Lower mother’s education associated with lower Lower mother’s education associated with lower screening ratescreening rate

Infants with low birth weight and associated Infants with low birth weight and associated conditions have a higher rate of screeningconditions have a higher rate of screening

Infants receiving hearing services at 9 months Infants receiving hearing services at 9 months also receive many additional services also receive many additional services

ProspectusProspectus

EHDIEHDI Annual data collection allows trend analysis to Annual data collection allows trend analysis to

document increase in newborn hearing screeningdocument increase in newborn hearing screening

Anticipate more extensive data will come in future yearsAnticipate more extensive data will come in future years

ECLS-BECLS-B Longitudinal study allows tracking of children with Longitudinal study allows tracking of children with

hearing problems (9 months of age – this study)hearing problems (9 months of age – this study)

Future data will be collected for children when 2, 4, Future data will be collected for children when 2, 4, 5 (kindergarten), and 6 (first grade) years old5 (kindergarten), and 6 (first grade) years old

Any Questions?Any Questions?

Documents

Infant Hearing Screening in the US, 2001: Results from the ECLS-B Study