National Surveillance to Close the Gap: Understanding Healthcare Access By Age in the Deaf Community

Background and purpose: Access to healthcare depends on cost, physical accessibility, social barriers, and patient satisfaction, as well as on availability of care. With 60% of deaf Americans over the age of 65, barriers to care for members of the Deaf community who use ASL as their primary language are substantial and pose great risk to health and wellbeing. Healthcare providers often view Deafness as pathology instead of a patient-centered view of Deaf culture. Available evidence suggests that lower rates of healthcare access and higher rates of delay and unmmet need are seen in two groups: adults over 65, and deaf adults, yet there exists a gap in the literature about healthcare access in the group of adults that are both geriatric and deaf. Since lower access to preventative and regular healthcare is associated with increased hospitalizations, worse overall health, and increased healthcare costs, addressing this knowledge gap could help to mitigate such negative outcomes for a vulnerable population.

Methods: Using the BRFSS dataset from the CDC, we used logistic regression models and chi-square tests to examine deafness, age, and delays in getting treatment in primary care settings.

Results: Older adults are about half as likely as young adults to have a delay in getting medical care (OR=.51), while deaf patients are nearly twice as likely as hearing patients to have a delay (OR=1.7). The interactive effect was unexpected, however; the delay in healthcare access is more significant for younger adult deaf patients than for geriatric deaf patients, and for both deaf and hearing adults, the difference in delay of care between younger and geriatric patients is significant.

Conclusions and Implications: In this American population, younger adults who are deaf (n=1,758) are at a higher risk of delaying healthcare than either their hearing (n=50,520) or deaf geriatric (n=2,850) counterparts, although barriers for older deaf adults remain substantial and concerning. Some of this variance may be explained by the presence of health insurance such as Medicare in the older population. Compared to hearing patients, deaf patients are nearly twice as likely to have delays in accessing care at any age. This may be due to difficulty interacting with staff, lack of sign language interpreters at medical offices, and/or a general mistrust of physicians due to past experiences. Further research should examine the underlying reasons for variance among age groups.