Cosmos Study

Childhood Speech Delay Rates Have Not Fallen After Post-Pandemic Surge

January 16, 2025

Team A:Kersten Bartelt, RNJoe Deckert, PhD

Team B:Matthew Gracianette, MDEric Barkley

Key Findings

Speech delay diagnoses among toddlers increased between Q1 2018 and Q4 2021 and remained steady at 16-17% in 2023 and 2024.

We previously reported that the rate of childhood speech delays increased significantly between 2018 and 2023 compared to the 2018 average and had been on an upward trajectory since the beginning of the COVID-19 pandemic.¹ We wanted to understand how that trajectory has trended since that publication: whether rates have continued to rise, have plateaued, or have fallen. We anticipated that the rates would have fallen because children who have turned two in recent years were not exposed to the social and behavioral changes during the height of the pandemic.

We studied 1,343,835 children who turned two between Q1 2018 and Q3 2024. Similar to our prior study, we found that the rate increased most sharply between 2020 and 2021, as seen in Figure 1. Rates continued to rise slowly into 2022 and have remained relatively stable since then.

Figure 1

Speech Delay Diagnosis Rate by Age Two

Figure 1. The rate of speech delay diagnoses by age two by quarter.

The plateau in rates was observed across all populations studied, including those living in rural and urban areas, males and females, all races, and all Social Vulnerability Index quartiles. In this study, we modified our methods to reduce selection bias, which resulted in a higher pre-pandemic rate than previously reported.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 289 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Bartelt K, Gracianette M, Deckert J, Franklin B, Little D, Barkley E. Childhood Speech Development Delays Increasing Since the Start of the Pandemic. Epic Research. https://epicresearch.org/articles/childhood-speech-development-delays-increasing-since-the-start-of-the-pandemic. Accessed on December 3, 2024.

Data Definitions

Study period: Q1 2018 and Q3 2024

Study population

Patients who had a well child visit between 23 and 27 months of age* that falls in the study period with three or more prior face-to-face encounters.
Exclusions:

Patients with a diagnosis of pervasive developmental delays or hearing loss

*The previous version of this study required a visit between 2 and 6 years old instead of a 2-year-old well child visit.

Well child visit

Encounter with one of the following:

CPT code 99391-99393 or 99381-99383
ICD-10-CM code Z00.1*
Encounter type of “well child”

Face-to-face encounter: Encounters of the following types: “Allied Health,” “Ancillary Procedure,” “Anticoagulation Visit,” “Audiology,” “Case Management,” “Clinical Support,” “Confidential,” “Consult,” “Diagnostic Services,” “Education,” “Emergency,” “Evaluation,” “Fetal Care Consult,” “Fetal Procedure,” “Follow-up,” “Genetics,” “Home Care Visit,” “Hospice F2F Visit,” “Hospital,” “Hospital Encounter,” “Immunization,” “Induction,” “Infusion,” “Initial Prenatal,” “Injection,” “Lactation Consult,” “Lactation Encounter,” “Multidisciplinary Visit,” “NST,” “Nurse Only,” “Nursing Home,” “Nutrition,” “Office Visit,” “Oncology Survivorship,” “Ophth Exam,” “Occupational/Physical Therapy,” “Postpartum Visit,” “Procedural Consult,” “Procedure Visit,” “Radiology Appointment,” “REI,” “Research Encounter,” “Routine Prenatal,” “Sleep Study,” “Social Work,” “Speech Therapy,” “Surgery,” “Surgical Consult,” “Telemedicine,” “Transplant Evaluation,” “Transplant Follow Up,” “Treatment,” “Urgent Care,” “Walk-in,” or “Well Child.”

Pervasive developmental delays: A diagnosis with ICD-10-CM code F84*

Hearing loss: A diagnosis with ICD-10-CM code F80.4*, H90*, H91*, P09.6, Z46.1, or Z01.110

Speech delays: A diagnosis with ICD-10-CM code F80* (except F80.4*)