2020 Summary of National CDC EHDI Data

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Data Source: 2020 CDC Early Hearing Detection and Intervention (EHDI) Hearing Screening & Follow-up Survey (HSFS)

Background:

The CDC’s National Center on Birth Defects and Developmental Disabilities promotes the health of babies, children, and adults, with a focus on preventing birth defects and developmental disabilities and optimizing the health outcomes of those with disabilities. As part of these efforts, the Center is actively involved in addressing the early identification of permanent hearing loss among newborns and infants. Hearing loss affects between 1 and 2 per 1,000 infants in the United States and, when left undetected, can delay a child’s speech and language, social, and emotional development.1

To ensure children with permanent hearing loss are identified as soon as possible, states and territories have implemented Early Hearing Detection and Intervention (EHDI) programs. These EHDI programs work to ensure all infants are screened for hearing loss, ideally before 1 month of age; receive diagnostic audiologic evaluation (for those not passing the screening), ideally before 3 months of age; and are enrolled in early intervention (for those identified with permanent hearing loss), ideally before 6 months of age.2 The Hearing Screening & Follow-up Survey is a voluntary survey sent out annually by CDC to each state and territorial EHDI program that requests non-estimated hearing screening, diagnostic, and intervention information on infants born in a specified calendar year (e.g., 2020). The survey helps to assess the progress of EHDI efforts to identify infants with permanent hearing loss across the United States. This summary of the 2020 HSFS highlights EHDI-related information for babies born between January 1, 2020 and December 31, 2020.

Number of Survey Respondents: 57α (48 states, 7 territories, 1 district) AL, AK, American Samoa, AZ, AR, CA, CO, Commonwealth of the Northern Mariana Islands, CT, DE, District of Columbia, FL, GA, Guam, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, Micronesia, MN, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, Palau, PA, Puerto Rico, RI, SC, SD, TN, TX, UT, VT, Virgin Islands, VA, WA, WV, WI, WY

1American Speech-Language-Hearing Association (ASHA). Effects of hearing loss on development. Available at: https://www.asha.org/public/hearing/effects-of-hearing-loss-on-development.
Accessed April 8, 2021

2Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs (2020). Journal of Early Hearing Detection and Intervention, 4(2), 1-44. https://digitalcommons.usu.edu/jehdi/vol4/iss2/1/

2020 Documented EHDI Data Items
2020 Documented EHDI Data Items*
Total Occurrent Births (according to state & territorial EHDI programs) 3,587,350
Documented Hearing Screening
Percent Screened 98.2% (n = 3,521,854)
(Range: 92.3% – 100.0%)
  • Percent Screened (excluding infant deaths & parental refusals)
 98.7%
  • Percent Screened before 1 Month of Age
 97.2% (n = 3,423,979)
Percent Not Passing final / most recent screening 1.9% (n = 68,741)
No Documented Hearing Screening
Percent w. No Documented Screening: 1.8% (n = 65,496)
Documented Diagnosis
Percent Diagnosed 60.0% (n = 42,330)
(Range: 0.0 – 100.0%)
  • Percent with No Hearing Loss (i.e., no diagnosed hearing loss)
   51.1% (n = 36,009)
  • Percent with Permanent Hearing Loss
    9.0% (n = 6,321)
  • Percent Diagnosed (no hearing loss + transient hearing loss + permanent hearing loss) before 3 Months of Age
    60.6% (n = 25,671)
Prevalence of Permanent Hearing Loss 1.8 per 1,000 screened
No Documented Diagnosis
Percent w. No Documented Diagnosis 39.9% (n = 28,121)
  • In Process
   1.8% (n = 1,266)
  • Infant Died / Parents Declined
   3.6% (n = 2,502)
  • Non-Resident / Moved
   2.6% (n = 1,842)
  • Overall Percent Loss to Follow-up (LFU) / Loss to Documentation (LTD) for Diagnosis∞
  • LFU/LTD = # Parents/Family Contacted but Unresponsive (6,057) + # Unable to Contact (3,473) + # Unknown (11,482)
 29.8% (n = 21,012)
(Range: 0.0 – 86.6%)
    • Percent LFU / LTD for Diagnosis: Due to Unable to Contact and Unknown
 21.2% (n = 14,955)
    • Percent Unresponsive for Diagnosis: Due to Parents/Family Contacted but Unresponsive
 8.6% (n = 6,057)
Other Cases of Hearing Loss
Number of Additional Cases (e.g., late-onset hearing loss & infants not screened at birth) n = 518
Documented Referral to Early Intervention (EI)
Percent Referred to Part C EI (of those with hearing loss) 78.6% (n = 4,971)
Percent Not Referred to Part C and Unknown (of those with hearing loss) 9.2% (n = 580)
Documented Enrollment in EI
Percent Enrolled in EI (Part C & Non-Part C)
  • Enrolled in EI = # in Part C EI (3,768) + # in Non-Part C EI (115)
 61.4% (n = 3,883)
(Range 12.5% – 100.0%)
  • Percent Enrolled in EI before 6 Months of Age (Part C & Non-Part C)
 72.4% (n = 2,810)
No Documented Enrollment in EI
Percent w. No Documented EI Services 38.6% (n = 2,438)
  • Infant Died / Parents Declined
     10.4% (n = 659)
  • Non-Resident / Moved
     2.4% (n = 154)
  • Not Eligible for Part C Services
     1.2% (n = 73)
  • Overall Percent Loss to Follow-up (LFU) / Loss to Documentation (LTD) for EI∞
  • LFU/LTD = # Parents/Family Contacted but Unresponsive (178) + # Unable to Contact (348) + # Unknown (706)
19.5% (n = 1,232)
(Range 0.0 – 75.4%)
  • Percent LFU / LTD for EI: Due to Unable to Contact and Unknown
    16.7% (n = 1,054)
  • Percent Unresponsive for EI: Due to Parents/Family Contacted but Unresponsive
    2.8% (n = 164)

*Notes:

In many regions the COVID-19 pandemic interrupted the delivery of healthcare services in 2020, including newborn hearing screening and follow-up diagnostic and intervention services. As a result, infants born in 2020 and needing hearing screening and/or follow-up services may have experienced delays or had difficulties obtaining these services.

Please see below for an explanation of the calculations for the above EHDI data items.

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Meeting the EHDI 1-3-6 Benchmarks by Denominator
(U.S., 2020)

Bar chart showing: Meeting the EHDI 1-3-6 Benchmarks by Denominator (U.S. 2020) details below.

Note: Label inside each bar represents the denominator used (e.g., All Births or Infants Screened). Please see below for calculations.

Meeting the EHDI 1-3-6 Benchmarks by Denominator (U.S., 2020)

Screened by 1 Month

  • All Births = 95.4%
  • Infants Screened = 97.2%

Diagnosed by 3 Months

  • Infants Not Pass Screen = 36.3%
  • Infants Diagnosed = 60.6%

EI by 6 Months

  • Infants with HL = 44.5%
  • Infants Receiving EI = 72.4%

EI = Early Intervention

1-3-6 Formulas (different denominators allow for review of status and progress based on different but relevant criteria)

Screened by 1 Month (Denominator: of all births):
3,423,979 (# pass before 1 month + # not pass before 1 month) / 3,587,350 (births reported by EHDI) x 100 = 95.4%
Mean: 94.9
IQR: (94.2-96.5)

Screened by 1 Month (Denominator: of infants screened):
3,423,979 (# pass before 1 month + # not pass before 1 month) / 3,521,854 (# screened) x 100 = 97.2%
Mean: 97.0
IQR: (96.6-98.2)

Diagnosed by 3 Months (Denominator: of infants not passing screen and infants not screened because referred straight to diagnostic evaluation):
25,671 (# diagnosed with no hearing loss before 3 months + # with permanent hearing loss before 3 months) / 70,451 (infants not pass screen + infants not screened because referred straight to diagnostic evaluation) = 36.4%
Mean: 37.5
IQR: (18.2-56.1)

Diagnosed by 3 Months (Denominator: of infants diagnosed):
25,671 (# diagnosed with no hearing loss before 3 months + # with transient hearing loss before 3 months +  # diagnosed with permanent hearing loss before 3 months) / 42,330 (# w. documented diagnostic evaluation) x 100 = 60.6%
Mean: 64.8
IQR: (56.7-77.5)

Early Intervention by 6 Months (Denominator: of infants with permanent hearing loss):
2,810 (# enrolled in Part C EI before 6 months + # in Non-Part C EI before 6 Months) / 6,321 (with permanent hearing loss) x 100 = 44.5%
Mean: 44.2
IQR: (30.8-55.9)

Early Intervention by 6 Months (Denominator: of infants enrolled in early intervention):
2,810 (# enrolled in Part C EI before 6 months + # in Non-Part C EI before 6 Months) / 3,883 (# enrolled in Part C + # in non-Part C EI) x 100 = 72.4%
Mean: 69.2
IQR: (61.0-81.4)

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Data Notes
  • Hearing Screening and Follow-up Survey data reflect information that states and territories have reportedly documented without estimation. As a result, data reported by CDC EHDI may differ from other sources.
  • Some respondents provided only partial data (e.g., hearing screening data only). As a result, the number of reporting states and territories and denominators varies for some of the data sections.
  • These data are subject to change if additional states and/or territories report data for year 2020.
  • In Process: Respondents were advised that to be reported in this category, each infant must have been seen for diagnostic evaluation at least one time and have a follow-up appointment already scheduled.
  • LFU (Loss to Follow-up) / LTD (Loss to Documentation): Subgroup of “No Documented Diagnosis / Undetermined” and “No Intervention Services / Undetermined” include cases where infants’ families were Contacted but Unresponsive, Unable to Contact, and Unknown.

Explanation of 2020 EHDI Data Item Calculations *

*Based on data from 57 respondents (48 states, 7 territories, 1 district)

Documented Hearing Screening

Percent Screened
3,521,854 (# screened) / 3,587,350 (occurrent births reported by EHDI programs) x 100 = 98.2%

  • Percent Screened (excluding infant deaths & parental refusals)
    3,521,854 (# screened) / 3,568,257 (occurrent births excluding infant deaths & parental refusals) x 100 = 98.7%
  • Percent Screened Before 1 Month of Age
    3,423,979 (# pass before 1 month + # not pass before 1 month) / 3,521,854 (# screened) x 100 = 97.2%

Percent Not Passing final / most recent hearing screening
68,741 (# not pass) / 3,521,854 (# screened) x 100 = 1.9%

No Documented Hearing Screening

Percent with No Documented Hearing Screening
65,496 (# w. no documented screening) / 3,587,350 (# occurrent births reported by EHDI programs) x 100 = 1.8%

Documented Diagnosis

Percent Diagnosed
42,330 (# w. documented diagnosis) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 60.1%

  • Percent with No Hearing Loss
    36,009 (# w. no hearing loss) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 51.1%
  • Percent with Permanent Hearing Loss
    6,321 (# w. diagnosed permanent hearing loss) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 9.0%
  • Percent Diagnosed Before 3 Months of Age
    25,671 (# w. no hearing loss before 3 months + # w. permanent hearing loss before 3 months) / 42,330 (# w. documented diagnosis) x 100 = 60.6%

Prevalence of Hearing Loss
6,321 (# w. diagnosed permanent hearing loss) / 3,520,924 (# screened) x 1,000 = 1.8 per 1,000 screened

No Documented Diagnosis

Percent with No Documented Diagnosis (of those not passing hearing screen and not screened because referred straight to diagnostic evaluation)
28,121 (# w. no documented diagnosis) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 39.9%

  • Percent in Process
    1,266 (# in process) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 1.8%
  • Percent Infant Died / Parents Declined Services
    2,502 (# infant died + # parents declined services) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 3.6%
  • Percent Non-Resident or Moved Out of Jurisdiction
    1,842 (# non-resident + # moved out of jurisdiction) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 2.6%
  • Overall Percent LFU / LTD for Diagnosis (i.e., Unable to Contact / Unresponsive / Unknown)
    21,012 (# unable to contact + # unresponsive + # unknown) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 29.8%
  • Percent LFU/LTD for Diagnosis: Due to Unable to Contact and Unknown
    14,955 (# unable to contact + # unknown) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 21.2%
  • Percent Unresponsive for Diagnosis: Due to Parents/Family Contacted but Unresponsive
    6,057 (# parents/family contacted but unresponsive) / 70,451 (# not pass screen + not screened because referred straight to diagnostic evaluation) x 100 = 8.6%

Documented Referral to EI

Percent Referred to Part C EI (of those with permanent hearing loss)
4,971 (# referred to Part C EI) / 6,321 (# w. permanent hearing loss) x 100 = 78.6%

  • Percent Not Referred to Part C and Unknown (of those with permanent hearing loss)
    580 (# not referred to Part C + # unknown) / 6,321 (# w. permanent hearing loss) x 100 = 9.2%

Documented Enrollment in EI

Percent Enrolled in EI (Part C & Non-Part C)
3,883 (# enrolled in Part C + # in non-Part C EI) / 6,321 (# w. permanent hearing loss) x 100 = 61.4%

  • Percent Enrolled in EI before 6 Months of Age (Part C & Non-Part C)
    2,810 (# enrolled in Part C EI before 6 months + # in Non-Part C EI before 6 Months) /
    3,883 (# enrolled in Part C + # in non-Part C EI) x 100 = 72.4%

No Documented Enrollment in EI

Percent with No Documented EI Services (of those with permanent hearing loss)
2,438 (# not receiving any EI services) / 6,321 (# w. permanent hearing loss) x 100 = 38.6%

  • Percent Infant Died / Parents Declined (of those with permanent hearing loss)
    659 (# infant died + # parents declined services) / 6,321 (# w. permanent hearing loss) x 100 = 10.4%
  • Percent Non-Resident / Moved (of those with permanent hearing loss)
    154 (# non-resident + # moved out of jurisdiction) / 6,321 (# w. permanent hearing loss) x 100 = 2.4%
  • Percent Not Eligible for Part C Services (of those with permanent hearing loss)
    73 (# not eligible for Part C services) / 6,321 (# w. permanent hearing loss) x 100 = 1.2%
  • Percent LFU / LTD for EI
    1,232 (# unable to contact + # unresponsive + # unknown) / 6,321 (# w. permanent hearing loss) x 100 = 19.5%
  • Percent LFU/LTD for EI: Due to Unable to Contact and Unknown
    1,054 (# unable to contact + # unknown) / 6,321 (# w. permanent hearing loss) x 100 = 16.7%
  • Percent Unresponsive for EI: Due to Parents/Family Contacted but Unresponsive
    178 (# parents/family contacted but unresponsive) / 6,321 (# w. permanent hearing loss) x 100 = 2.8%
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Table of Contents

  1. 2020 Annual Data
  2. ›2020 Summary of National CDC EHDI Data
  3. 2020 Summary of Hearing Screening Among Total Occurent Births
  4. 2020 Summary of Detailed Hearing Screening Results
  5. 2020 Summary of Infants Screened Before 1 Month of Age
  6. 2020 Summary of Reasons for No Documented Hearing Screening Among Total Occurrent Births
  7. 2020 Summary of Diagnostics Among Infants Not Passing Hearing Screening
  8. 2020 Summary of Infants Not Passing Hearing Screening Diagnosed Before 3 Months of Age
  9. 2020 Summary of Reasons for No Documented Diagnosis Among Infants Not Passing Hearing Screening
  10. 2020 Summary of Early Intervention (EI) Among Infants Identified with Permanent Hearing Loss
  11. 2020 Summary of Infants Identified with Permanent Hearing Loss Enrolled in Early Intervention (EI) Before 6 Months of Age
  12. 2020 Summary of Reasons for No Documented Early Intervention (EI) Services Among Infants Identified with Permanent Hearing Loss
  13. 2020 Type and Severity Summary of Identified Cases of Hearing Loss
  14. 2020 Demographics
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