Introduction

Since universal Newborn Hearing Screening (NBHS) was mandated two decades ago, the Centers for Disease Control and Prevention (CDC) has collected data from each State’s NBHS program annual report. The annual report includes many metrics involving screening, diagnosis, and early intervention of Deaf and Hard of Hearing (DHOH) newborn babies. While the amount of data is impressive, the ability to determine relative or absolute progress by state or nationally is not easy. Hearing Loss prevalence (HLp), arguably one of the most significant of these metrics, was chosen to facilitate comparisons between states.

In this presentation, HLp data for the period 2007-2019 are presented in several interactive formats making it easier to learn the relative or absolute progress any state made in this period. It also illustrates the overall national progress the NBHS program has made since 2007.

HLp was chosen because it is arguably the most meaningful early hearing detection and intervention (EHDI) metric; Early Intervention cannot commence until DHOH babies are found. It is also the quotient of two highly reliable metrics, the CDC defined “Hearing Loss” and “Total Screened,” the former because it is the result of audiological/medical diagnoses, and the latter because most states successfully screen a very high percentage of its newborn babies.

Some may find HLp unfamiliar because, compared to other metrics such as “Loss to Follow-Up” or “Total Screened,” it is not commonly emphasized in EHDI reports and communications. With Hearing Loss being normalized to Total Screened, HLp as a metric allows a population independent comparison over time within a state, between states, and the United States as a whole. Clearly visible is the overall increase in HLp the US has made over this period, although there are suggestions of a slowing trend 2018-9. For many states, these data may be a source of pride and satisfaction about the progress of their programs. For others, it may well be a source of concern.

Thanks to Todd Combs and Douglas Luke from the Center for Public Health Systems Science at the Brown School at Washington University in St. Louis, who are responsible for the creative presentation of these data compiled by James W. Seeser. Comments or suggestions may be sent here

Using the icons above the figures, you will discover many ways to view these data. If you get lost in the data, press the home button to return to the original graph. Have fun!



States above and below 2019 median HLp value by year, 2007-2019

Figure 1 displays the numbers of states above and below the 2019 median HLp value of 1.79. Apparent is the overall positive impact on US HLp of the EHDI program over this period. Many states significantly improved their individual HLp. Mouse over the bars to see the percentage of states reporting above or below the 2019 median each year.


States above and below 2019 median HLp value (1.79) by year, 2007-2019



Smoothed line plots

Figure 2 shows the actual reported prevalence by state (pink lines) and smoothed trend lines (green) to discard small year-to-year variations. States are ordered from top to bottom by their latest HLp values. The black dots represent the US median in 2019 for comparison. Remove either type of line from all states in the figure by clicking on the legend (bottom right).


Smoothed line plots: HLp by state, 2007-2019



Comparison line plots

Figure 3 shows the reported prevalences by state and for the US overall along with annual mean and median. Hover over a point to get state, year, HLp value, and quartile (Highest, Moderately High, Moderately Low, Lowest). Click on a line or point to isolate it, or choose one or more lines to compare from the dropdown menu. Double-click in the whitespace to bring all the lines back. To zoom in after selecting states for comparison, drag and drop the mouse from left to right over the plot area. If applicable, the range of the axes will change to fit the selection.

Notes:


HLp by state and in the aggregate, 2007-2019



Boxplots

Figure 4 shows the distributions of states’ HLp values in boxplots by year. The area in the box begins with the first quartile (25th percentile). The middle line represents the median data point, and the top of the box is the third quartile (75th percentile). The whiskers (lines beyond the box) show the minimum value on the bottom,or the lower fence when outliers are present. The upper fence is at the top of the line. The fence values represent where the minimum and maximum values would be if the distribution were normal. Dots above and below the whiskers represent outliers. Mouse over the boxes and whiskers to view all these statistics.

The overall trend for the median and maximum values for states’ HLp is increasing most years, though small decreases in some years. This year-to-year oscillation is likely statistical noise.

State HLp distribution by year, 2007-2019

Table 1 shows the numbers by year.



States’ HLp values by year, 2007-2019
State 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
AK 1.585 1.774 1.797 1.877 1.642 2.074 1.823 1.750 1.764 1.78 0.803 1.761 1.711
AL 1.070 1.033 0.754 1.221 2.31 1.648 1.897
AR 0.896 0.856 1.081 0.816 1.056 1.123 0.859 1.342 1.026 1.18 1.798 2.166 1.796
AZ 1.436 1.410 1.252 1.684 1.772 1.824 1.414 1.899 2.223 2.40 2.168 2.256 2.338
CA 1.802 1.829 1.816 1.952 1.896 2.054 2.296 2.13 2.186 2.155 2.087
CO 1.543 1.655 1.993 1.822 1.748 1.804 1.994 2.152
CT 1.576 1.596 1.971 1.778 2.022 1.355 2.491 1.956 2.789 2.21 2.139 2.396 2.632
DE 2.219 0.953 0.864 1.765 0.807 1.225 2.187 1.54 1.094 1.426 1.486
FL 0.789 0.985 1.063 0.880 0.823 1.090 1.069 1.071 1.340 1.31 1.345 1.223 1.228
GA 1.471 1.677 1.818 1.619 1.574 1.721 1.72 1.880 1.662 1.326
HI 3.657 3.704 3.154 3.288 2.791 2.909 3.259 3.330 4.058 3.98 3.545 4.537 3.860
IA 1.501 2.106 1.661 1.655 1.147 1.266 1.725 1.721 1.741 1.89 1.932 2.320 1.540
ID 1.111 1.539 1.939 1.942 2.584 3.046 2.886 1.906 2.862 1.42 2.143 1.755 2.331
IL 1.157 1.109 1.337 1.189 1.654 1.845 2.05 2.168 2.119 2.292
IN 1.505 1.576 1.542 1.620 1.943 1.764 1.905 2.000 1.359 1.53 2.511 2.480 2.189
KS 1.333 1.341 1.366 1.731 1.604 2.288 2.091 1.767 1.431 1.77 1.409 1.765 1.803
KY 0.902 0.833 1.593 1.511 1.390 1.091 1.052 1.570 1.689 1.90 1.762 0.986 1.186
LA 0.791 1.003 0.886 0.986 1.067 1.074 0.920 0.929 1.315 1.44 1.386 1.089 1.785
MA 2.726 2.630 2.846 2.627 2.455 2.765 2.194 2.463 2.551 2.45 2.088 2.658 2.004
MD 1.105 1.805 0.676 0.896 1.327 1.122 1.299 1.209 1.506 1.33 1.391 0.976 1.330
ME 1.397 1.366 1.075 1.360 1.792 1.865 1.543 2.037 2.563 1.07 1.781 1.960 1.423
MI 1.105 1.054 1.050 1.288 1.490 1.467 1.406 1.548 1.481 1.58 1.538 1.437 1.646
MN 1.330 1.524 1.845 1.686 2.140 2.426 2.496 2.290 2.425 2.327 2.825
MO 1.644 0.764 1.167 1.317 1.602 1.340 1.215 1.664 1.621 1.34 1.560 1.308 1.274
MS 1.906 1.999 1.900 1.980 1.738 2.046 1.616 1.657 1.574 1.21 1.465 1.870
MT 0.937 0.826 2.137 2.000 2.424 1.204 0.839 2.248 1.878 1.74 1.909 1.064 1.111
NC 1.434 1.464 1.567 1.650 1.617 1.580 1.993 1.850 1.659 1.78 1.641 1.884 1.955
ND 0.416 0.592 0.794 2.050 1.033 2.107 1.523 1.892 1.185 1.01 1.867 1.895 1.349
NE 1.859 1.598 1.592 1.690 2.238 1.378 1.866 2.671 2.188 2.30 1.953 2.292 2.038
NH 2.920 1.944 1.543 1.058 1.399 1.576 2.484 1.67 1.705 1.452 1.829
NJ 0.841 0.974 1.103 0.914 1.156 1.280 1.373 1.225 1.149 1.40 1.282 1.141 0.943
NM 2.215 2.472 2.816 3.654 2.643 1.535 1.715 2.541 1.90 2.445 1.719 1.494
NV 0.726 0.963 1.236 1.203 1.707 1.498 1.41 1.871 1.649 1.599
NY 0.657 1.323 1.41 1.487 1.694 1.327
OH 0.760 1.309 1.068 1.341 1.581 1.547 1.623 1.493 1.475 1.49 1.942 2.103 1.945
OK 2.029 1.510 1.766 1.629 1.818 1.451 1.356 1.507 1.735 2.01 1.764 1.487 1.656
OR 1.560 2.605 1.693 1.643 1.896 1.868 2.290 2.325 2.718 2.47 2.234 2.449 2.256
PA 1.073 1.316 1.436 1.286 1.289 1.518 1.498 1.457 1.252 1.24 1.676 1.464 1.233
RI 1.067 1.026 0.661 1.450 1.374 1.036 1.225 2.566 3.63 3.153 3.914
SC 1.342 1.440 1.114 1.062 1.213 1.617 1.666 1.438 1.986 2.16 1.854 1.949 2.126
SD 0.634 0.642 0.325 0.576 1.063 2.163 2.288 2.583 2.349 2.36 2.964 1.237 2.383
TN 0.610 0.879 0.846 0.756 0.754 1.003 0.792 1.016 1.601 1.59 1.728 1.424 1.936
TX 0.657 0.889 1.163 0.855 1.100 1.092 0.686 1.170 1.235 1.12 1.116 1.210 1.044
UT 1.216 1.203 1.309 1.235 2.013 1.928 2.359 2.015 1.911 2.05 1.989 1.821 1.950
VA 1.163 1.307 0.975 1.479 1.374 1.614 1.412 1.554 1.666 1.53 1.628 1.492 1.121
VT 1.973 0.871 1.068 0.883 1.420 0.528 1.613 1.210 1.582 1.45 2.018 1.899 3.308
WA 1.535 1.589 1.451 1.414 1.573 1.855 1.890 2.160 1.897 2.13 1.832 2.087 1.952
WI 1.419 1.424 1.276 1.378 1.526 1.676 1.687 1.853 2.159 1.91 1.804 1.940 1.666
WV 0.398 0.576 0.245 0.336 0.438 0.268 0.565 0.783 0.21 0.268 0.768 0.540
WY 2.648 3.440 2.685 2.809 2.421 2.724 1.470 2.328 2.706 3.04 1.949 2.881 3.085



Heatmap

In Figure 4 states are ranked and color coded in 4 fixed HLp ranges. These ranges are determined by 2019 quartiles. In this way, it is possible to see how the distribution of states (in the fixed intervals defined in the key) has changed over time. States are ordered from highest (top) to lowest (bottom) average HLp (top to bottom). Mouse over any box for more information. Click on a state or states to isolate all years for the selection.

Note:


Heatmap: HLp by state (Quartiles), 2007-2019