Redefining the survival of the fittest: Communication disorders in the 21st century

Research output: Contribution to journalArticlepeer-review

281 Scopus citations


Objectives:To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design:Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method:Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results:Communication disorders are estimated to have a prevalence of 5 to 10. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5 to 3 of the Gross National Product. Conclusions:Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.

Original languageEnglish (US)
Pages (from-to)241
Number of pages1
Issue number2
StatePublished - Feb 2000


  • Outcomes
  • communication disorders
  • costs
  • economics
  • employment
  • hearing
  • language
  • speech
  • voice

ASJC Scopus subject areas

  • Otorhinolaryngology


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