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oai:figshare.com:article/33970450 2026-09-23T04:42:43Z category_7 portal_316 item_type_3 month_year_09_2026

Table 1_Geospatial analysis of hearing-related services utilization among Medicare beneficiaries, 2017–2021.docx Jeffrey Li (2573977) Vinay Veluvolu (25094038) Mark Nyaeme (16259861) Mitchell Heuermann (25094041) Medicine audiology disparities geospatial analysis health services research hearing-care access Medicare Moran's I otolaryngology Background<p>Approximately 30 million Americans report hearing loss, yet hearing-aid uptake remains low, and access to audiology and otolaryngology services varies markedly across the United States. Geographic patterns of Medicare billed hearing-related services have not been systematically characterized at the county level, and the socioeconomic correlates of utilization clusters remain underexplored.</p>Methods<p>A retrospective cross-sectional ecological analysis was performed on publicly available 2017–2021 county-level data from the Centers for Medicare & Medicaid Services Physician, the US Census Bureau American Community Survey, and the USDA Economic Research Service. Hearing-related procedures were identified using American Speech Language Hearing Association classified Healthcare Common Procedure Coding System. Spatial autocorrelation of county level total service volume was assessed using global Moran's I and Local Indicators of Spatial Association computed in PySAL (α = 0.05), classifying each county as high–high, low–low, high–low, or low–high; based on the county's value relative to the national mean and its neighbors' average. The four cluster groupings were compared across 50 socioeconomic variables using one-way ANOVA. Per-capita utilization, used for descriptive mapping, was calculated using total county population from the American Community Survey; the rationale and implications of this denominator choice are detailed in the Methods.</p>Results<p>1,340 contiguous-US counties, with Medicare billing activity, were included in the spatial analysis (290.7 million residents). Over 5 years, 15,136,056 hearing-related procedures were billed at a total Medicare payment of $428.3 million (Global Moran's I = 0.49, p < 0.01). Sixty-eight counties were classified as hot-spot clusters. Concentrated in Southern California, Florida, Texas, and the Mid-Atlantic and encompassing 75.5 million residents, 4.9 million procedures, and $159.0 million in spending. One hundred twenty-five counties were classified as cold-spot clusters, primarily across the Midwest and Deep South, encompassing 5.2 million residents, 316,177 procedures, and $7.3 million in spending. Cold spots had substantially higher poverty rates (14.7% vs. 11.3%), lower median household incomes ($56,239 vs. $86,972), and lower educational attainment than hot spots; hot spots showed greater racial and ethnic diversity.</p>Conclusion<p>Hearing-related Medicare service utilization exhibits substantial geographic clustering, with rural and economically disadvantaged regions showing systematic underutilization. These findings priority regions for workforce expansion and policy intervention.</p> 2026-09-23T04:42:43Z Dataset Dataset 10.3389/fauot.2026.1885939.s001 https://figshare.com/articles/dataset/Table_1_Geospatial_analysis_of_hearing-related_services_utilization_among_Medicare_beneficiaries_2017_2021_docx/33970450 CC BY 4.0