Sociodemographic disparities and clinical predictors of cochlear implant quality of life: evidence from Saudi Arabia.

Quality of life (QoL) is a critical outcome measure for cochlear implant (CI) users, yet the association between sociodemographic disparities, respondent type, and QoL remains under-explored in the Saudi Arabian context. This study aimed to examine the relationship between sociodemographic and clinical factors specifically respondent type (self-report vs. proxy-report), socioeconomic status, and device usage and CI-related quality of life domains. A cross-sectional observational study was conducted involving 156 participants (CI users and parents/guardians) recruited via digital rehabilitation networks in Saudi Arabia. Data were collected using a structured electronic questionnaire incorporating the modified Cochlear Implant Quality of Life-35 Profile (CIQOL-35). Multiple linear regression models (OLS) were estimated to evaluate factors associated with six QoL domains: communication, emotional, entertainment, environment, listening effort, and social functioning. The regression analysis indicated that family economic status was significantly associated with better outcomes in the communication, environment, and social domains (p < .05). Conversely, parents with higher education levels reported significantly lower scores in the communication and environment domains (β = - 0.37 and - 0.38, respectively, p < .05) compared to those with primary education, potentially reflecting an expectation bias. Notably, respondent type (adult self-report vs. proxy-report) did not demonstrate a statistically significant association with emotional well-being or other domains in this model. Clinical factors such as lack of post-implant habilitation were associated with significantly lower scores across multiple domains. Sociodemographic factors are significantly associated with perceived quality of life among CI users in Saudi Arabia. While families with higher economic resources report better social and environmental outcomes, highly educated parents perceive lower benefits, potentially reflecting differences between clinical outcomes and parental expectations. These findings suggest that rehabilitation programs must integrate psychosocial support that addresses family expectations and socioeconomic barriers to optimize QoL outcomes. Interpretations should be contextualized within the study's limitations, notably a proxy-dominant sample and the use of a modified instrument not originally validated for pediatric proxy reports.