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Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to health care services for hearing health care services for hearing health care services for hearing health

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SLIDE 1

Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to health care services for hearing health care services for hearing health care services for hearing health care services for hearing impairment? impairment? impairment? impairment?

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SLIDE 2

Hearing loss in UK adults Hearing loss in UK adults Hearing loss in UK adults Hearing loss in UK adults

14.3% 15.0% 16.9% 17.1% 16.1% 0.0% 5.0% 10.0% 15.0% 20.0% Denmark Finland Sweden Italy UK

Prevalence of hearing loss Country

Source: 1-5

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SLIDE 3

Higher incidence of hearing loss among; Higher incidence of hearing loss among; Higher incidence of hearing loss among; Higher incidence of hearing loss among;

  • Men

Men Men Men 6

6 6 6-

  • 9

9 9 9

  • Persons with cardiovascular risk factors

Persons with cardiovascular risk factors Persons with cardiovascular risk factors Persons with cardiovascular risk factors 10-14

  • Ethnic minorities

Ethnic minorities Ethnic minorities Ethnic minorities 15

  • Persons of low socioeconomic status (SES)

Persons of low socioeconomic status (SES) Persons of low socioeconomic status (SES) Persons of low socioeconomic status (SES) 6,7,13,15,16

Hearing health inequalities Hearing health inequalities Hearing health inequalities Hearing health inequalities

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SLIDE 4

Low SES is associated with; Low SES is associated with; Low SES is associated with; Low SES is associated with;

  • Unhealthy behaviours

Unhealthy behaviours Unhealthy behaviours Unhealthy behaviours 17,18

  • Manual labour / industrial occupation

Manual labour / industrial occupation Manual labour / industrial occupation Manual labour / industrial occupation 19,20

Relationship between SES and hearing loss Relationship between SES and hearing loss Relationship between SES and hearing loss Relationship between SES and hearing loss

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SLIDE 5

Pilot study Pilot study Pilot study Pilot study

  • First hearing aid fitting appointments

First hearing aid fitting appointments First hearing aid fitting appointments First hearing aid fitting appointments

  • Retrospective analysis between 2015

Retrospective analysis between 2015 Retrospective analysis between 2015 Retrospective analysis between 2015-

  • 18

18 18 18

  • Compare by age and SES

Compare by age and SES Compare by age and SES Compare by age and SES

  • Welsh Index of Multiple Deprivation as a surrogate

Welsh Index of Multiple Deprivation as a surrogate Welsh Index of Multiple Deprivation as a surrogate Welsh Index of Multiple Deprivation as a surrogate for SES for SES for SES for SES

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SLIDE 6

Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD)

  • Lower Super Output Areas

Lower Super Output Areas Lower Super Output Areas Lower Super Output Areas (LSOAs) (LSOAs) (LSOAs) (LSOAs)

  • 1909 LSOAs in Wales

1909 LSOAs in Wales 1909 LSOAs in Wales 1909 LSOAs in Wales

  • Average population of 1600

Average population of 1600 Average population of 1600 Average population of 1600 people per LSOA people per LSOA people per LSOA people per LSOA

Source: Stats Wales 21

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SLIDE 7

5% 5% 5% 23.5% 23.5% 14% 14% 10%

WIMD rank WIMD rank WIMD rank WIMD rank

Source: Welsh Government 22

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SLIDE 8

WIMD by health board WIMD by health board WIMD by health board WIMD by health board

  • Seven health boards

Seven health boards Seven health boards Seven health boards responsible for all of Wales responsible for all of Wales responsible for all of Wales responsible for all of Wales

  • Abertawe

Abertawe Abertawe Abertawe Bro Bro Bro Bro Morgannwg Morgannwg Morgannwg Morgannwg University health board University health board University health board University health board (ABMU) (ABMU) (ABMU) (ABMU)

Source: Welsh Government 21

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SLIDE 9

Most deprived Least deprived

LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary

  • 327 LSOAs

327 LSOAs 327 LSOAs 327 LSOAs

  • Lowest = 6

Lowest = 6 Lowest = 6 Lowest = 6

  • Highest = 1908

Highest = 1908 Highest = 1908 Highest = 1908

Source: Welsh Government 21

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SLIDE 10

Most deprived Least deprived

LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary

Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10

  • 10 “decile” groups

10 “decile” groups 10 “decile” groups 10 “decile” groups

  • 9 Groups contained 33 LSOAs

9 Groups contained 33 LSOAs 9 Groups contained 33 LSOAs 9 Groups contained 33 LSOAs

  • 1 Group contained 30 LSOAs

1 Group contained 30 LSOAs 1 Group contained 30 LSOAs 1 Group contained 30 LSOAs

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SLIDE 11

ABMU total 1 ABMU total 1 ABMU total 1 ABMU total 1st

st st st fit appointments by year

fit appointments by year fit appointments by year fit appointments by year

2836 2844 2455 2664 500 1000 1500 2000 2500 3000 2015 2016 2017 2018 Number of first fit appointments Year

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SLIDE 12

ABMU 1 ABMU 1 ABMU 1 ABMU 1st

st st st fit appointments by year & age

fit appointments by year & age fit appointments by year & age fit appointments by year & age

100 200 300 400 500 600 700 800 900 18-30 31-40 41-50 51-60 61-70 71-80 >80 Number of first fit appointments Age group 2015 2016 2017 2018

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SLIDE 13

1 1 1 1st

st st st Fit appointments by deprivation group

Fit appointments by deprivation group Fit appointments by deprivation group Fit appointments by deprivation group

  • Age demographics vary between LSOAs

Age demographics vary between LSOAs Age demographics vary between LSOAs Age demographics vary between LSOAs

  • Number of

Number of Number of Number of 1 1 1 1st

st st st fit appointments alone may give

fit appointments alone may give fit appointments alone may give fit appointments alone may give skewed results. skewed results. skewed results. skewed results.

  • 1

1 1 1st

st st st Fit appointment rate as a proportion of;

Fit appointment rate as a proportion of; Fit appointment rate as a proportion of; Fit appointment rate as a proportion of;

  • Population within ABMU

Population within ABMU Population within ABMU Population within ABMU

  • Population within deprivation group

Population within deprivation group Population within deprivation group Population within deprivation group

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SLIDE 14

1 1 1 1st

st st st Fit appointments all adults (>18)

Fit appointments all adults (>18) Fit appointments all adults (>18) Fit appointments all adults (>18)

0.2 0.4 0.6 0.8 1 1.2 1.4 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.2 0.4 0.6 0.8 1 1.2 1.4 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

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SLIDE 15

1 1 1 1st

st st st Fit appointments by year (18

Fit appointments by year (18 Fit appointments by year (18 Fit appointments by year (18-

  • 30)

30) 30) 30)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

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SLIDE 16

1 1 1 1st

st st st Fit appointments by year (31

Fit appointments by year (31 Fit appointments by year (31 Fit appointments by year (31-

  • 40)

40) 40) 40)

0.00 0.50 1.00 1.50 2.00 2.50 3.00 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.50 1.00 1.50 2.00 2.50 3.00 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2017) Linear (2018) Linear (2016)

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SLIDE 17

1 1 1 1st

st st st Fit appointments by year (41

Fit appointments by year (41 Fit appointments by year (41 Fit appointments by year (41-

  • 50)

50) 50) 50)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

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SLIDE 18

1 1 1 1st

st st st Fit appointments by year (51

Fit appointments by year (51 Fit appointments by year (51 Fit appointments by year (51-

  • 60)

60) 60) 60)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

slide-19
SLIDE 19

1 1 1 1st

st st st Fit appointments by year (61

Fit appointments by year (61 Fit appointments by year (61 Fit appointments by year (61-

  • 70)

70) 70) 70)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

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SLIDE 20

1 1 1 1st

st st st Fit appointments by year (71

Fit appointments by year (71 Fit appointments by year (71 Fit appointments by year (71-

  • 80)

80) 80) 80)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2018) Linear (2018)

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SLIDE 21

1 1 1 1st

st st st Fit appointments by year (>80)

Fit appointments by year (>80) Fit appointments by year (>80) Fit appointments by year (>80)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group 2015 2016 2017 2018 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 1 2 3 4 5 6 7 8 9 10 11 Comparison of proportions Deprivation group Linear (2015) Linear (2016) Linear (2017) Linear (2018)

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SLIDE 22

Summary of findings Summary of findings Summary of findings Summary of findings

  • Overall

Overall Overall Overall 1 1 1 1st

st st st hearing

hearing hearing hearing aid aid aid aid fitting fitting fitting fitting appointments appointments appointments appointments are are are are being being being being accessed accessed accessed accessed evenly evenly evenly evenly between between between between deprivation deprivation deprivation deprivation groups groups groups groups

  • Age

Age Age Age of

  • f
  • f
  • f accessing

accessing accessing accessing hearing hearing hearing hearing aids aids aids aids varies varies varies varies by by by by deprivation deprivation deprivation deprivation group group group group

  • Those

Those Those Those living living living living in in in in the the the the most most most most deprived deprived deprived deprived areas areas areas areas are are are are accessing accessing accessing accessing interventions interventions interventions interventions younger younger younger younger

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SLIDE 23

Limitations Limitations Limitations Limitations

  • Are these observations statistically significant?

Are these observations statistically significant? Are these observations statistically significant? Are these observations statistically significant?

  • Use of WIMD rank as surrogate of individual SES

Use of WIMD rank as surrogate of individual SES Use of WIMD rank as surrogate of individual SES Use of WIMD rank as surrogate of individual SES

  • Influence of private

Influence of private Influence of private Influence of private healthcare services? healthcare services? healthcare services? healthcare services?

  • No objective measures of hearing loss

No objective measures of hearing loss No objective measures of hearing loss No objective measures of hearing loss

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SLIDE 24
  • Majority of adults with a hearing loss do not wear

Majority of adults with a hearing loss do not wear Majority of adults with a hearing loss do not wear Majority of adults with a hearing loss do not wear hearing hearing hearing hearing aids aids aids aids 23-27

  • Hearing help seeking and hearing aid use not

Hearing help seeking and hearing aid use not Hearing help seeking and hearing aid use not Hearing help seeking and hearing aid use not associated with associated with associated with associated with SES SES SES SES 28,29

  • Can we use hearing

Can we use hearing Can we use hearing Can we use hearing aid fitting as a proxy for aid fitting as a proxy for aid fitting as a proxy for aid fitting as a proxy for significant hearing significant hearing significant hearing significant hearing loss loss loss loss

First hearing aid fitting appointments First hearing aid fitting appointments First hearing aid fitting appointments First hearing aid fitting appointments

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SLIDE 25

Going forward Going forward Going forward Going forward

  • Statistical analysis

Statistical analysis Statistical analysis Statistical analysis

  • Investigate hearing threshold when accessing

Investigate hearing threshold when accessing Investigate hearing threshold when accessing Investigate hearing threshold when accessing hearing aids hearing aids hearing aids hearing aids

  • Investigate access to all audiology services

Investigate access to all audiology services Investigate access to all audiology services Investigate access to all audiology services

  • Investigate

Investigate Investigate Investigate why why why why people people people people living living living living in in in in more more more more deprived deprived deprived deprived areas areas areas areas appear appear appear appear to to to to be be be be accessing accessing accessing accessing hearing hearing hearing hearing aids aids aids aids younger younger younger younger

  • Repeat throughout NHS trusts

Repeat throughout NHS trusts Repeat throughout NHS trusts Repeat throughout NHS trusts

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SLIDE 26

References References References References

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SLIDE 27

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Agrawal Agrawal Agrawal, Y., , Y., , Y., , Y., Platz Platz Platz Platz, E. A., , E. A., , E. A., , E. A., Niparko Niparko Niparko Niparko, J. K. (2009). Risk factors for hearing loss in US adults: data from the , J. K. (2009). Risk factors for hearing loss in US adults: data from the , J. K. (2009). Risk factors for hearing loss in US adults: data from the , J. K. (2009). Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. National Health and Nutrition Examination Survey, 1999 to 2002. National Health and Nutrition Examination Survey, 1999 to 2002. National Health and Nutrition Examination Survey, 1999 to 2002. Otol Otol Otol Otol Neurotol Neurotol Neurotol Neurotol, , , , 30. 30. 30.

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SLIDE 28

13. 13. 13.

  • 13. Helvik

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