2026 Early Hearing Detection & Intervention Conference
March 15-17, 2026 • Jacksonville, FL
| Demographic Disparities in Diagnostic Evaluation Completion Following Failed Newborn Hearing Screening in Georgia, 2020–2024
Demographic Disparities in Diagnostic Evaluation Completion Following Failed Newborn Hearing Screening in Georgia, 2020–2024
Background: Audiological evaluation following failed newborn hearing screening (NBHS) is critical for diagnosing infant hearing loss and initiating early intervention. This study examined demographic and geographic disparities among Georgia-born infants receiving a diagnostic evaluation versus those lost to follow-up (LTFU).
Methods: Georgia birth records were linked to NBHS and diagnostic records using SAS. Maternal race/ethnicity, education, marital status, insurance, WIC enrollment, Public Health District (PHD) location, and maternal age were compared between infants receiving a diagnostic versus those LTFU using chi-square and t-tests. Follow-up coordinator to resident birth (C:B) ratio was calculated by PHD location. Binomial regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for receiving a diagnostic.
Results: Among 11,028 Georgia-born infants (2020–2024) failing NBHS, 5,442 (49.3%) received a diagnostic and 5,586 (50.7%) were LTFU. Infants of younger mothers were consistently less likely to receive a diagnostic compared to those of older mothers >= age 34 (ages 12–24 years: RR=0.80, 95% CI: 0.75–0.86; ages 25–29 years: RR=0.86, 95% CI: 0.81–0.91; ages 30–33 years: RR=0.91, 95% CI: 0.86–0.96). Infants of mothers with <=12th grade education were 6% less likely to receive a diagnostic (RR=0.94, 95% CI: 0.90–0.99) than those with higher education. Medicaid coverage was associated with a 9% lower likelihood of diagnostic evaluation (RR=0.91, 95% CI: 0.86–0.96) compared to private insurance. Infants in districts with below-average C:B ratio (<2.95 per 100,000) were 27% less likely to receive a diagnostic (RR=0.73, 95% CI: 0.69–0.76) than infants in districts above the mean.
Conclusions: Disparities exist in diagnostic follow-up after failed NBHS in Georgia, particularly among infants of younger mothers, less-educated mothers, Medicaid-insured, and in districts with low coordinator capacity. Strengthening follow-up capacity and targeting at-risk groups could improve diagnostic evaluation and initiation of early intervention.
- Identify demographic variables associated with infants lost to follow-up for a diagnostic evaluation after failing newborn hearing screening.
- Describe the statistical tests and modeling performed on demographic variables to identify which are associated with infants lost to follow-up for a diagnostic evaluation after failing newborn hearing screening.
- Apply the methods and findings from this study to identify infant populations in your state who are at greater risk of being lost to follow-up for a diagnostic evaluation after failing newborn hearing screening.
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Presenters/Authors
Michael Lo
(Primary Presenter), Georgia Department of Public Health, michael.lo@dph.ga.gov;
Michael Lo is a Newborn Surveillance Epidemiologist at the Georgia Department of Public Health, where he has provided data analysis support to Georgia's EHDI program since 2015. He is funded by and supports Georgia’s EHDI information system grant from CDC in multiple capacities, including surveillance, evaluation and performance monitoring, and health informatics. He has no financial relationships or interests to disclose.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
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No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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Financial relationship with Centers for Disease Control and Prevention.
Nature: I receive salary support from CDC's EHDI information systems cooperative agreement grant.
Nonfinancial -
No relevant nonfinancial relationship exists.
Brandt Culpepper
(Co-Author), Georgia Department of Public Health , brandt.culpepper@dph.ga.gov;
Dr. Brandt Culpepper is the Early Hearing Detection and Intervention Program Team Lead at the Georgia Department of Public Health. She received her B.S. and M.S. degrees from the University of Georgia and her Ph.D. from the University of Washington. She has more than 30 years of experience as an audiologist with interest in infant and pediatric audiology. She has worked in public health, clinical, medical, and academic environments. Dr. Culpepper has no financial interests in corporate organizations with products that may be relevant to this presentation.
ASHA DISCLOSURE:
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AAA DISCLOSURE:
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Ankit Sutaria
(Co-Author), Georgia Department of Public Health, ankit.sutaria@dph.ga.gov;
Dr. Ankit Sutaria is a Newborn Surveillance Epidemiologist and the Newborn Surveillance Team Lead at the Georgia Department of Public Health.
ASHA DISCLOSURE:
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AAA DISCLOSURE:
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Tonia Ruddock
(Co-Author), Georgia Department of Public Health, tonia.ruddock@dph.ga.gov;
Dr. Tonia Ruddock is the Child Health Epidemiology Director at the Georgia Department of Public Health.
ASHA DISCLOSURE:
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AAA DISCLOSURE:
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Cherie Drenzek
(Co-Author), Georgia Department of Public Health, cherie.drenzek@dph.ga.gov;
Dr. Cherie L. Drenzek is the State Epidemiologist and Chief Science Officer at the Georgia Department of Public Health.
ASHA DISCLOSURE:
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AAA DISCLOSURE:
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