Geographic and Racial Disparities in Infant Hearing Loss.


Objective Approximately 1 to 2 of every 1000 American newborns has hearing loss identified by newborn screening. This study was designed to determine if infant hearing loss is more common in socioeconomically disadvantaged communities. Study Design In this retrospective study, we analyzed electronic medical record data using geostatistical models. Setting Infants were residents of Durham County, North Carolina, born in 2 hospitals of the Duke University Health System. This county includes the city of Durham and surrounding suburban and rural communities. Subjects and Methods Subjects were hearing-screened newborns, born between 2005 and 2016, whose residential address was in Durham County, North Carolina. This was a retrospective study using medical record data. We used Bayesian regression models with smoothing of coordinate date to identify both spatial and nonspatial predictors of infant hearing loss. Results We identified 19,348 infants from Durham County, of whom 675 had failed initial hearing screening and 191 had hearing loss confirmed on follow-up. Hearing loss was significantly associated with minority race (odds ratio [OR], 2.45; 95% confidence interval, 1.97-3.06), as well as lower gestational age and maternal sexually transmitted infections. We identified significant geographic heterogeneity, with a higher probability of hearing loss in poorer urban neighborhoods (local OR range, 0.59-1.39). Neighborhood disadvantage was a significant predictor of hearing loss, as was high local seroprevalence of cytomegalovirus (CMV) among pregnant women. Conclusions Urban, low-income neighborhoods have a high prevalence of infant hearing loss compared with more affluent surrounding communities, particularly among minorities. This distribution may be attributable to congenital CMV infection.





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Publication Info

Lantos, Paul M, Gabriela Maradiaga-Panayotti, Xavier Barber, Eileen Raynor, Debara Tucci, Kate Hoffman, Sallie R Permar, Pearce Jackson, et al. (2018). Geographic and Racial Disparities in Infant Hearing Loss. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. p. 194599818803305. 10.1177/0194599818803305 Retrieved from

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Paul Michael Lantos

Professor of Medicine

I am interested in the spatial epidemiology of infectious diseases. My research utilizes geographic information systems (GIS) and geostatistical analyses to understand the spatial and spatiotemporal distribution of diseases, and their relationship with environmental and demographic factors. I currently have active studies evaluating the spatial distribution of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19), cytomegalovirus, influenza, and Lyme disease. Additionally I am interested in maternal-child health, and I have a number of ongoing studies of neighborhood health disparities in obstetrical care and birth outcomes. I am interested in GIS education and have conducted workshops on public health GIS in Mongolia and China.


Eileen Margolies Raynor

Associate Professor of Head and Neck Surgery & Communication Sciences

I am interested in multidisciplinary management of pediatric patients with an emphasis on minimizing anesthesia exposures and coordination of care.  I also focus on communication abilities including pediatric voice disorders working with voice therapists in the Duke Voice Care Center.  I enjoy congenital head and neck surgery as well as airway, endoscopic sinus and otology.  My research interests include collaborative projects with other disciplines and using technology to determine surgical outcomes.


Debara Lyn Tucci

Adjunct Professor in the Department of Head and Neck Surgery & Communication Sciences

The focus of current research efforts is in defining the effects of conductive hearing impairment on the development and function of the central auditory system. The ultimate goal of this research is to understand the impact of hearing loss, such as that associated with otitis media, on the development of auditory function in children. Experiments are currently being performed in which central auditory system activity is studied using the 2-deoxyglucose method following unilateral neonatal conductive hearing loss. Future experiments will examine changes in cell structure and interneuronal connections following acute and chronic conductive hearing loss in both neonatal and adult animals.

A second research program is focused on issues related to the cochlear implant. The cochlear implant is a device which allows for electrical stimulation of the auditory nerve in profoundly deaf patients. It has previously been demonstrated in animal studies as well as in human tissue histopathology that degeneration of central auditory pathways occurs following severe damage to the inner ear. It has been suggested that the introduction of electrical stimulation via a cochlear implant may prevent or reverse some of these degenerative changes. Experiments conducted previously examined this issue in the neonatally and adult deafened rat. Tissue analysis is currently undergoing completion.


Kate Hoffman

Associate Research Professor in The Division of Environmental Sciences and Policy

Sallie Robey Permar

Adjunct Professor in the Department of Pathology

Dr. Permar's work focuses on the development of vaccines to prevent vertical transmission of neonatal viral pathogens. She has utilized the nonhuman primate model of HIV/AIDS to characterize the virus-specific immune responses and virus evolution in breast milk and develop a maternal vaccine regimen for protection against breast milk transmission of HIV. In addition, Dr. Permar's lab has advanced the understanding of HIV-specific immune responses and virus evolution in vertically-transmitting and nontransmitting HIV-infected women, defining maternal immune responses that may protect against neonatal transmission of HIV. Importantly, Dr. Permar has established a nonhuman primate model of congenital CMV infection adn is using this model to establish the maternal immune responses that are necessary for protection against placental virus transmission. Finally, Dr. Permar is studying the impact and prevention of postnatal CMV transmission in preterm infants.


Brenna L Hughes

Professor of Obstetrics and Gynecology

Geeta Krishna Swamy

Haywood Brown, MD Distinguished Professor of Women's Health

Dr. Geeta Swamy, MD, is Professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine, having served as the director of the Duke Perinatal Research Center and Vice Chair for Research and Faculty Development in the Department of ObGyn. She has achieved international acclaim as a clinician researcher and expert in the field of maternal immunization and perinatal infection. As a consultant to the World Health Organization, Dr. Swamy contributes her knowledge to advance international work to evaluate the immunogenicity, safety, and efficacy of vaccines in pregnant women. The American College of ObGyn has grown to be the “collective voice” for women’s health, and Dr. Swamy has been a leader within that organization for the last two decades. She currently serves as the Co-Principal Investigator for the NIH-NIAID Vaccine Treatment and Evaluation (VTEU) and CDC Clinical Immunization Safety Assessment. In addition, she has been a leader at Duke and nationally in promoting a culture of scientific integrity and transparency in research. She has been instrumental in developing and leading the School of Medicine’s research initiatives in administration, regulatory oversight, and compliance. In 2018, she became Vice Dean for Scientific Integrity in the School of Medicine and Associate Vice President for Research for Duke University. In these roles she oversees the Duke Office of Scientific Integrity (DOSI) which houses the Advancing Scientific Integrity, Services, & Training (ASIST) initiative, conflict of interest, clinical quality management, incident response in research, and research misconduct. She also oversees the Duke Office of Research Initiatives, the Duke Health IRB, Office of Research Administration (ORA), and Office of Research Contracts (ORC). 

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