Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e124">IMPORTANCE</h5> <p id="P1">As the American population ages, effective healthcare planning requires understanding changes in hearing loss prevalence. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e129">OBJECTIVE</h5> <p id="P2">Determine if age- and sex-specific prevalence of adult hearing loss changed during the past decade. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e134">DESIGN</h5> <p id="P3">Analysis of 2011–2012 National Health and Nutrition Examination Survey (NHANES) audiometric data compared to NHANES 1999–2004. NHANES is a cross-sectional, nationally-representative interview and examination survey of the civilian, non-institutionalized population. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e139">PARTICIPANTS</h5> <p id="P4">A stratified random sample of 3,831 adults aged 20–69 years</p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e144">INTERVENTIONS</h5> <p id="P5">Audiometry and questionnaires</p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e149">MAIN OUTCOMES AND MEASURES</h5> <p id="P6">Speech-frequency hearing impairment (HI) defined by pure-tone average (PTA) of thresholds across 0.5–1–2–4 kHz greater than 25 dB hearing level (HL); high-frequency HI defined by PTA across 3–4–6 kHz &gt;25 dB HL. Logistic regression was used to examine unadjusted, age- and sex-adjusted, and multivariable-adjusted associations with demographic, noise exposure, and cardiovascular risk factors. </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e154">RESULTS</h5> <p id="P7">The 2011–2012 unadjusted adult prevalence of unilateral and bilateral speech-frequency HI was 14.1%, compared to 16% for 1999–2004; after age- and sex-adjustment, the difference was significant, odds ratio (OR)=0.70 (95% confidence interval [95% CI]: 0.56–0.86). Men had nearly twice the prevalence of speech-frequency HI, 18.6% (17.8 million), compared to women, 9.6% (9.7 million). For 60–69 year-olds, speech-frequency HI prevalence was 39.3% (95% CI: 30.7%–48.7%). In multivariable analyses for bilateral speech-frequency HI, age was the major risk factor; however, men, non-Hispanic (NH) white and NH Asian race, lower educational attainment, and heavy use of firearms all had significant associations. Additional associations for high-frequency HI were Mexican-American and Other Hispanic race/ethnicity and the combination of loud and very loud noise exposure occupationally and outside of work, OR=2.4 (95% CI: 1.4–4.2). </p> </div><div class="section"> <a class="named-anchor" id="S8"> <!-- named anchor --> </a> <h5 class="section-title" id="d14980369e159">CONCLUSIONS AND RELEVANCE</h5> <p id="P8">Adult hearing loss is common and strongly associated with age and other demographic factors (sex, race/ethnicity, education). Noise exposure, which is preventable, was less strongly associated. Cardiovascular risk factors – heavy smoking, hypertension, and diabetes – were significant only in unadjusted analyses. Age- and sex-specific HI prevalence continues to decline. Despite the benefit of delayed onset of HI, hearing healthcare needs will increase as the U.S. population grows and ages. </p> </div>