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Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey

Authors:
  • Retired from Statistics Canada

Abstract

In Canada, population-level estimates of hearing loss have been based on self-reported data, yielding estimates of 4% or 5%. Self-reported hearing difficulties may result in underestimates of hearing loss, particularly among people with mild loss and among older adults. The 2012/2013 Canadian Health Measures Survey (cycle 3) collected audiometric and self-reported data to estimate the prevalence of hearing loss and limitations in a population-based sample of Canadians aged 20 to 79. Weighted frequencies and cross-tabulations were used to calculate measured and self-reported hearing levels by sociodemographic characteristics. All estimates were weighted at the person-level to represent the population. Based on a pure-tone average of four frequencies that are important in speech, 19.2% of Canadians aged 20 to 79 had measured hearing loss in at least one ear; 35.4% had high-frequency hearing loss. These levels exceeded the self-reported estimate of hearing difficulty-3.7%-derived from responses to questions from the Health Utilities Index Mark 3. The prevalence of measured hearing loss rose with age from no more than 10% among people younger than 50 to 65% at ages 70 to 79. Men were more likely than women to have a hearing loss, a difference that emerged around age 60. Canadians with low household income and/or educational attainment were more likely than those in higher income/education households to have a hearing loss. This analysis presents the first population-based audiometric data on the prevalence of hearing loss among the adult household population of Canada, and highlights the disparity between measured and self-reported outcomes.
Health Reports
Catalogue no. 82-003-X
ISSN 1209-1367
by Katya Feder, David Michaud, Pamela Ramage-Morin, James McNamee
and Yves Beauregard
Prevalence of hearing loss among
Canadians aged 20 to 79: Audiometric
results from the 2012/2013 Canadian
Health Measures Survey
Release date: July 15, 2015
Standard table symbols
The following symbols are used in Statistics Canada
publications:
. not available for any reference period
.. not available for a specic reference period
... not applicable
0 true zero or a value rounded to zero
0
s
value rounded to 0 (zero) where there is a meaningful
distinction between true zero and the value that was rounded
p
preliminary
r
revised
x suppressed to meet the condentiality requirements
of the Statistics Act
E
use with caution
F too unreliable to be published
* signicantly different from reference category (p < 0.05)
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18
Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015 • Statistics Canada, Catalogue no. 82-003-X
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
Prevalence of hearing loss among Canadians aged 20 to 79:
Audiometric results from the 2012/2013 Canadian Health
Measures Survey
by Katya Feder, David Michaud, Pamela Ramage-Morin, James McNamee and Yves Beauregard
Abstract
Background: In Canada, population-level estimates of hearing loss have been based on self-reported data, yielding estimates of 4% or 5%. Self-reported
hearing difculties may result in underestimates of hearing loss, particularly among people with mild hearing loss and among older adults.
Data and methods: The 2012/2013 Canadian Health Measures Survey (cycle 3) collected audiometric and self-reported data to estimate the prevalence of
hearing loss and limitations in a population-based sample of Canadians aged 20 to 79. Weighted frequencies and cross-tabulations were used to calculate
measured and self-reported hearing levels by sociodemographic characteristics. All estimates were weighted at the person-level to represent the population.
Results: Based on a pure-tone average of four frequencies that are important in speech, 19.2% of Canadians aged 20 to 79 had measured hearing loss in at
least one ear; 35.4% had high-frequency hearing loss. These levels exceeded the self-reported estimate of hearing difculty—3.7%—derived from responses
to questions from the Health Utilities Index Mark 3. The prevalence of measured hearing loss rose with age from no more than 10% among people younger
than 50 to 65% at ages 70 to 79. Men were signicantly more likely than women to have a hearing loss, a difference that emerged around age 60. Canadians
with low household income and/or educational attainment were more likely than those in higher income/education households to have a hearing loss.
Interpretation: This analysis presents the rst population-based audiometric data on the prevalence of hearing loss among the adult household population
of Canada, and highlights the disparity between measured and self-reported outcomes.
Keywords: Audiometry, deafness, earwax, hearing aids, hearing-impaired persons, hearing loss
H
earing loss is an important public health concern with far-
reaching implications. At the beginning of the twenty-
rst century, the World Health Organization reported adult-
onset hearing loss to be one of the leading causes of years
lived with disability (YLD); in 2000, hearing loss accounted
for 4.7% of total YLD due to all causes, with the total global
YLD for hearing loss estimated at 24.9 million.
1,2
As well,
hearing loss has been associated with worse quality of life and
functional outcomes.
3
The personal consequences may include
social isolation, depression, safety issues, mobility limitations,
and reduced income and employment opportunities.
4-6
Yet
despite the importance of hearing for daily functioning, hearing
loss is often unrecognized and undertreated.
3,7
In Canada, the prevalence of hearing loss has typically been
estimated through self-reports. For example, according to the
Canada Community Health Survey and the Participation and
Activity Limitations Survey, the self-reported prevalence of
hearing impairment was 4% and 5% for the population aged
12 or older and 15 or older, respectively.
8,9
However, self-re-
ports may result in underestimates, especially among older
adults and among people with mild hearing loss.
10-13
Survey
respondents may not self-identify as having a hearing disability
and/or may not even be aware of it, particularly if it is mild or
moderate.
14,15
Furthermore, hearing loss occurs gradually and
represents lifetime cumulative insults to the auditory system,
16,17
initially affecting the high frequencies and later progressing to
lower frequencies that can affect speech comprehension. Age of
onset varies, depending on factors such as genetic susceptibility,
the presence of diseases, and exposure to drugs that are toxic
to hearing.
16,18,19
Objective measurement of hearing acuity is necessary to
determine the extent of the problem.
20
Clinical studies using
audiometry have been carried out in specic populations and/or
age groups, but no population-based audiometrically measured
hearing data have been available for Canada.
The 2012/2013 Canadian Health Measures Survey (CHMS), a
population-based survey designed to provide national estimates
of health indicators, included both audiometric evaluations and
self-reports. This study presents an analysis of CHMS audio-
metric and self-reported hearing data for adults aged 20 to 79.
The study was approved by the Health Canada and Public Health
Agency of Canada Review Ethics Board (Protocol #2005-0025).
Methods
Data source
The data are from the Canadian Health Measures Survey (CHMS),
an ongoing survey that samples households in ve regions
across Canada (Atlantic, Quebec, Ontario, Prairies and British
Columbia). The survey entails an in-person, computer-assisted
household interview to gather demographic, socioeconomic,
health and lifestyle information, and a subsequent visit to a
mobile examination centre (MEC) for direct physical measures.
The CHMS excludes full-time members of the Canadian Forces;
residents of the three territories, First Nations Reserves and other
Aboriginal settlements, and certain remote regions; and residents
of institutions such as nursing homes. Together, these exclusions
make up about 4% of the target population. Proxy interviews are
accepted in cases of physical and/or intellectual impairment.
Authors: Katya Feder (Katya.Feder@hc-sc.gc.ca), David Michaud (David.Michaud@hc-sc.gc.ca) and James McNamee (James.McNamee@hc-sc.gc.ca) are
with the Health Effects and Assessment Division at Health Canada, Ottawa, Ontario. Pamela Ramage-Morin (Pamela.Ramage-Morin@statcan.gc.ca) is with
the Health Analysis Division at Statistics Canada, Ottawa, Ontario. Yves Beauregard is with the Audiology Department at the Children’s Hospital of Eastern
Ontario, Ottawa, Ontario.
19
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
Details about sampling design, data
collection and calculation of responses
rates are available elsewhere.
21
Screening
To account for potential temporary
threshold shift, CHMS respondents were
asked if they had listened to loud noise/
music in the previous 24 hours; 6.7% had
done so, but no signicant differences
were found in four-frequency pure-tone
average hearing loss between those who
reported exposure to loud noise/music
and those who did not.
Before testing, a visual inspection of
the outer ear ap (pinna) and entrance to
the ear canal was performed to identify
signs of infection, obstruction and other
conditions/circumstances that might
interfere with testing.
Hearing evaluation
Otoscopy was performed using the
Welch Allyn otoscope (Model 25020) to
identify gross abnormalities, including
the presence of blood, pus, excessive or
impacted ear wax, a growth, tumor or
foreign object in the ear canal, a collaps-
ible ear canal, or other occlusion. The
criteria for exclusion were: obstructed
ear canal, acute pain or infection, open
wounds or bandages covering the ear(s),
refusal to remove hearing aid, and
chronic ear conditions including con-
genital atresa or microtia of the ear canal
(one or both ears). No further testing was
performed if the individual was excluded
by otoscopy.
Tympanometry was conducted using
the A GSI 39 Auto Tympanometer. A
normal tympanogram was compliance
between 0.2 cm
3
to 1.8 cm
3
with middle
ear pressure between -150 and +50 daPa
in an equivalent ear canal volume of
between 0.75 cm
3
and 2.0 cm
3
. The cri-
teria for exclusion were: blood, pus or
impacted wax, eardrum perforation,
growth in the ear canal, and signicant
skin abnormality or discharge observed
during otoscopy. In these cases, audi-
ometry was performed using TDH-39
supra-aural headphones instead of insert
earphones.
Audiometric evaluation was carried
out by health measures specialists with
training/supervision provided by a certi-
ed audiologist, which included on-site
visits to ensure quality control. Testing
was conducted in a portable audiometric
booth (Eckel, AB-4230), using a comput-
er-controlled CCA-100 mini audiometer
with insert earphones (EAR 5A case) and
disposable foam ear tips or supra-aural
headphones (TDH-39). Hearing thresh-
olds were assessed at 0.5, 1, 2, 3, 4, 6
and 8 kHz. Testing followed procedures
recommended for standard audiometry
using automatic mode, except when the
respondent could not physically press
the response button or had very slow
response times, or when difculties were
noted with automatic mode. Manual
mode was carried out using the modi-
ed down-10 up-5 methodology.
22
The
audiometer was calibrated daily using
the Bio-Acoustic simulator BAS-200,
which served as a baseline. To avoid
interference with audiometric evalua-
tion, subjects were asked to refrain from
using chewing gum or candies. A Casella
CEL-633 sound level meter monitored
ambient sound pressure levels inside the
sound booth. Testing was paused if sound
pressure levels exceeded 55 dB for more
than 2 seconds. Respondents who refused
to sit in the audiometric booth with the
door closed or who had cognitive decits
that interfered with testing were excluded
from audiometric evaluation.
Self-reported hearing loss
To determine self-reported hearing
loss, the Health Utilities Index
Mark 3 (HUI3) hearing attribute was
administered.
23.24
HUI3 is a generic
preference-based measure of functional
health. Respondents were asked: “Are
you usually able to hear what is said in
a group conversation with at least three
other people without a hearing aid?”
Those who responded “no” were asked
follow-up questions: “Are you usually
able to hear what is said in a group con-
versation with at least three other people
with a hearing aid?,” “Are you able to
hear at all?,” “Are you usually able to
hear what is said in a conversation with
one other person in a quiet room without
a hearing aid?,” and “Are you usually
able to hear what is said in a conversa-
tion with one other person in a quiet
room with a hearing aid?” Responses
were scored according to an established
algorithm and classied as level 1 (no
hearing problems) to level 6 (unable
to hear at all). A dichotomous variable
identied individuals with hearing prob-
lems (levels 2 to 6) versus no hearing
problems (level 1).
Denitions
Hearing loss was dened as a unilat-
eral or bilateral hearing threshold above
25 dB in the worse ear, based on four-fre-
quency pure-tone average (PTA) across
0.5, 1, 2 and 4 kHz (frequencies gen-
erally associated with normal speech),
high-frequency PTA across 3, 4, 6, and
8 kHz, and low-frequency PTA across
0.5, 1 and 2 kHz. Unilateral and bilateral
hearing loss were mutually exclusive.
Hearing loss thresholds were based on
the American Speech-Language Hearing
Association guidelines
25
(Text table 1).
Occlusion of ear canal indicates
excessive earwax or pus observed during
otoscopic examination.
Household education was dened as
the highest level attained by a household
member, dichotomized as less than post-
secondary graduation and postsecondary
graduation or more.
Based on total annual income, three
household income categories were
dened: less than $50,000; $50,000 to
less than $100,000; and $100,000 or
more.
Respondents’ age was as of the date of
their MEC visit; education and income, as
of the date of their household interview.
Text table 1
Hearing loss categories and thresholds
for people aged 20 to 79
Hearing loss category
Hearing loss
threshold (dB)
Normal hearing 25 or lower
Mild loss 26 to 40
Moderate loss 41 to 70
Severe loss 71 to 90
Profound loss Above 90
Note: Based on American Speech-Language Hearing
Association guidelines.
25
20
Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015 • Statistics Canada, Catalogue no. 82-003-X
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
Table 1
Prevalence of measured four-frequency, low-frequency and high-frequency pure-tone average (PTA) hearing loss,
by selected characteristics, household population aged 20 to 79, Canada excluding territories, 2012/2013
Four-frequency
PTA hearing loss
Low-frequency
PTA hearing loss
High-frequency
PTA hearing loss
95%
confidence
interval
95%
confidence
interval
95%
confidence
interval
Characteristics Number % from to Number % from to Number % from to
'000 100.0 . . . . . . '000 100.0 . . . . . . '000 100.0 . . . . . .
Total 4,555 19.2 16.9 21.7 3,649 15.4
13.5 17.4 8,397 35.4
33.1 37.7
Sex
Men
2,986 25.3 20.9 30.4 2,158 18.3
15.5 21.5 4,849 41.2
36.5 46.0
Women 1,570 13.1** 11.0 15.6 1,491 12.5** 10.3 15.0 3,548 29.7*
24.9 35.0
Age group (years)
20 to 39 632
E
7.1
E
4.2 11.7 689
E
7.7
E
5.2 11.4 712
E
8.0
E
5.3 11.9
40 to 49 466
E
10.1
E
6.6 15.2 458
E
9.9
E
6.5 14.8 1,007
E
21.8
E
**
14.6 31.4
50 to 59 967 19.9* 14.1 27.3 592 12.2
9.0 16.2 2,387 49.1**
39.9 58.3
60 to 69 1,414 38.3** 34.4 42.3 1,091 29.5**
24.9 34.6 2,738 74.1**
70.1 77.7
70 to 79 1,076 65.0** 56.4 72.7 820 49.5**
41.3 57.7 1,553 93.8**
88.1 96.8
Household education
Less than postsecondary graduation 1,551 30.1** 23.8 37.2 1,218 23.6* 17.1 31.7 2,459 47.7*
37.2 58.4
Postsecondary graduation or more
2,919 15.9 13.4 18.9 2,397
E
13.1 10.9 15.6 5,734 31.3
27.6 35.3
Total household income
Less than $50,000
2,298 28.1 23.8 32.9 1,800 22.0
18.2 26.3 3,525 43.1
37.3 49.1
$50,000 to less than $100,000 1,316 16.5** 12.5 21.3 990 12.4** 9.3 16.3 2,609 32.6*
29.2 36.2
$100,000 or more 941 12.4
E
** 7.0 21.2 859 11.4
E
* 6.2 19.9 2,264 29.9*
23.1 37.8
reference category
* significantly different from reference category/preceding age group (p < 0.05)
** significantly different from reference category/preceding age group (p < 0.01)
significantly different from four-frequency hearing loss (p < 0.05)
E
use with caution
. . . not applicable
Four-frequency hearing loss = unilateral or bilateral, pure-tone average > 25dB over frequencies 0.5, 1, 2, and 4kHz
Low-frequency hearing loss = unilateral or bilateral, pure-tone average > 25dB over frequencies 0.5, 1, and 2kHz
High-frequency hearing loss = unilateral or bilateral, pure-tone average > 25dB over frequencies 3, 4, 6 and 8kHz
Source: 2012/2013 Canadian Health Measures Survey.
Results
In 2012/2013, an estimated 4.6 million
Canadians aged 20 to 79 (19%) had
hearing loss that affected their ability to
hear normal speech (Table 1). That is,
their audiometric tests revealed that their
pure-tone average (PTA) across the four
speech frequencies (0.5, 1, 2 and 4 kHz)
was greater than 25 dB.
For 12% of Canadian adults, hearing
loss was mild (26 dB to 40 dB) (Table 2).
These people would be less likely to
be aware of or self-report their hearing
difculty, and would cope by using
adaptive measures such as moving closer
to the source of the sound or increasing
the volume. For 7% of adults, hearing
loss was moderate or worse (41 dB or
above); these individuals would be more
likely to notice and self-report hearing
impairment.
Analytical techniques
Weighted frequencies and cross-tabula-
tions were used to estimate measured
and self-reported hearing levels by sex,
age group, total household income, and
highest household educational attain-
ment. All estimates were weighted at
the person level to represent the popu-
lation. Analyses were conducted using
SAS 9.1.3 and SAS-Callable SUDAAN
11.0.0 software. To account for the
complex survey design, p-values, 95%
condence intervals, and coefcients
of variation (CV) were estimated using
the bootstrap technique with 11 degrees
of freedom.
26,27
In the tables and text,
estimates with a CV of 16.6% to 33.3%
are agged with an E (interpret with
caution); those with a CV that exceeds
33.3% are not releaseable and are
designated F.
Study sample
The overall response rate for cycle 3 was
51.7%, yielding 5,785 respondents aged
3 to 79 who completed the household
questionnaire and MEC visit. The study
sample was established by excluding
2,601 respondents aged 19 or younger,
and a further 212 with the following con-
ditions: a) ear infection, cochlear implant
(56); b) collapsed ear canal or complete
obstruction of ear canal, pain/trauma to
ear, ear surgery within previous three
months, refusal to remove hearing aid or
participate in otoscopy (33); or c) incom-
plete or unacceptable audiometric testing,
including audiometry results for only
one ear (123). The nal study sample
comprised 2,972 respondents aged
20 to 79 (1,483 men and 1,489 women)
with bilateral audiometric results, repre-
senting 23.7 million Canadians.
21
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
Table 2
Percentage distribution of population, by measured hearing status in four-frequency and high-frequency pure-tone average
ranges and age group, household population aged 20 to 79, Canada excluding territories, 2012/2013
Normal hearing
(25 dB or lower)
Mild hearing loss
(26 to 40 dB)
Moderate or worse
hearing loss (41 dB or above)
95%
confidence
interval
95%
confidence
interval
95%
confidence
interval
Pure-tone average range, age group % from to % from to % from to
Four-frequency 80.8 78.3 83.1 12.1 10.2 14.2 7.1* 6.1 8.4
20 to 39 92.9 88.3 95.8 F ... ... F ... ...
40 to 49 89.9 84.8 93.4 7.1
E
4.0 12.3 3.0
E
* 1.8 5.0
50 to 59 80.1 72.7 85.9 14.6
E
8.5 23.9 5.3
E
* 2.8 9.9
60 to 69 61.7 57.7 65.6 25.0 20.8 29.6 13.3* 9.2 18.8
70 to 79 35.0 27.3 43.6 31.4 22.1 42.4 33.6 26.1 41.9
High-frequency 64.6 62.3 66.9 15.5 13.9 17.3 19.9* 18.3 21.6
20 to 39 92.0 88.1 94.7 F ... ... F ... ...
40 to 49 78.2 68.6 85.4 13.4
E
7.9 21.8 8.5
E
5.2 13.5
50 to 59 50.9 41.7 60.1 25.0 19.6 31.4 24.0
E
16.1 34.2
60 to 69 25.9 22.3 29.9 33.2 28.3 38.5 40.9* 34.8 47.3
70 to 79 6.2
E
3.2 11.9 19.0 13.3 26.4 74.8* 69.7 79.2
* significantly different from estimate for mild hearing loss (p < 0.05)
E
use with caution
F too unreliable to be published
... not applicable
Four-frequency hearing loss = unilateral or bilateral, pure tone average > 25dB over frequencies 0.5, 1, 2, and 4kHz
High-frequency hearing loss = unilateral or bilateral, pure-tone average > 25dB over frequencies 3, 4, 6 and 8kHz
Source: 2012/2013 Canadian Health Measures Survey.
Table 3
Prevalence of self-reported hearing difficulty, by selected characteristics, household
population aged 20 to 79, Canada excluding territories, 2012/2013
95%
confidence
interval
Characteristics Number % from to
'000
Total 867
E
3.7
E
2.2 6.0
Sex
Men
484
E
4.1
E
2.4 7.0
Women 383
E
3.2
E
1.7 5.9
Household education
Less than postsecondary graduation 357
E
7.0
E
3.5 13.5
Postsecondary graduation or more
505
E
2.8
E
1.5 5.2
Total household income
Less than $50,000
592
E
7.2
E
4.2 12.2
$50,000 to less than $100,000 192
E
2.4
E
** 1.5 3.7
$100,000 or more 84
E
1.1
E
** 0.5 2.3
reference category
** significantly different from reference category (p < 0.01)
E
use with caution
Note: Hearing difficulty was defined as level 2 to 6 on Health Utilities Index - Mark 3 (HUI3).
Source: 2012/2013 Canadian Health Measures Survey.
compared with 12% among those in
households where annual income was
$100,000 or more. Adults in households
with lower levels of education were
almost twice as likely as those in house-
holds where one or more members was a
postsecondary graduate to have a hearing
loss: 30% versus 16%.
Hearing loss measured over low
(0.5, 1 and 2 kHz) and high (3, 4, 6 and
8 kHz) frequencies generally followed the
same patterns as four-frequency hearing
loss. However, high-frequency hearing
loss was more common than four-fre-
quency hearing loss—35% (8.4 million)
versus 19% (4.6 million) of adults.
As well, people with high-frequency
hearing loss were more likely to have
hearing loss in both ears than in one
ear (data not shown). For those with
four-frequency hearing loss, the percent-
ages with bilateral and unilateral loss
were almost equal, while among those
with low-frequency hearing loss, unilat-
eral loss was more common.
The prevalence of measured hearing
loss (19%) far surpassed the percentage
of adults who reported difculties dif-
culties hearing, based on the HUI
Overall, a larger percentage of
men than women had four-frequency
hearing loss: 25% versus 13% (Table 1).
However, the difference emerged only
around age 60 (data not shown).
The prevalence of hearing loss rose
with advancing age. While no more
than 10% of people younger than 50
had four-frequency hearing loss, the
percentage was 65% among 70- to
79-year-olds.
Income and education were associ-
ated with hearing loss. The likelihood of
having four-frequency hearing loss was
28% among people in households where
annual income was less than $50,000,
22
Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015 • Statistics Canada, Catalogue no. 82-003-X
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
difculties, especially in cases of mild or
high-frequency hearing loss.
Comparisons of Canadian audio-
metric estimates with those of
population-based studies conducted in
the United States,
10,30
Great Britain
31
and
Australia
32
reveal consistent trends (Text
table 2). Discrepancies between CHMS
estimates and those of other surveys that
used audiometric measures may be due
to participant characteristics such as the
presence of earwax or the use of medica-
tions that affect hearing.
The male-female gap in the prevalence
of hearing loss starting around age 60 in
the CHMS data is fairly consistent with
global patterns, except that in other popu-
lations, the disparity emerged at younger
ages.
31-34
The differences may reect the
relatively small CHMS sample (2,972)
compared with other population-based
studies, some of which used several
years of data. Additional audiometric
data from future CHMS cycles may
yield greater consistency with global
trends. The higher prevalence of hearing
loss among men has been partly attrib-
uted to their greater likelihood of being
exposed to loud noise at work or during
leisure-time activities.
35
The present study shows increasing
bilateral hearing loss at older ages—the
percentage rose sharply in middle age,
and nearly doubled by ages 70 to 79.
The effect of aging on hearing acuity
is indisputable, but many factors inu-
ence the degree and rate of deterioration,
including genetic susceptibility, ototoxic
medication exposure, otological disor-
ders, smoking, and occupational and
leisure noise exposure.
7,16,18,30,36-40
In addi-
tion, an interaction between early noise
exposure and acceleration of hearing
loss has been postulated, with evidence
that the aging process is different in
noise-damaged cochlea (inner ear), com-
pared with unaffected cochlea.
41
Further
studies are warranted to investigate
factors related to hearing loss that were
outside the scope of this analysis.
The elevated prevalence of high-fre-
quency loss among older Canadians is in
line with research showing that age-re-
lated hearing loss begins in the highest
(fewer than 4%) (Table 3). No differ-
ence between men and women was
apparent in self-reported hearing dif-
culties, whereas the audiometric ndings
indicated that hearing loss was more
prevalent among men.
Overall, 12%
E
of adults with measured
hearing loss used a hearing aid (data not
shown). At ages 60 to 69, 9%
E
of those
with hearing loss wore hearing aids; at
ages 70 to 79, the gure was 24%
E
. An
estimated 25% of all moderately/severely
impaired individuals used a hearing aid.
Otoscopy revealed that 13% of
Canadian adults had occluding wax
or pus (one or both ears), which likely
affected their hearing acuity (data not
shown). The prevalence of earwax rose
from 11%
E
among 20- to 39-year-olds to
21% among people aged 70 to 79.
Discussion
This is the rst population-based study
to report audiometric data for Canadians.
According to results of the 2012/2013
CHMS, 19% of people aged 20 to 79
(4.6 million) had at least mild hearing
loss in frequencies that are important for
understanding speech. This far exceeded
the percentage who self-reported hearing
difculties—fewer than 4%.
This disparity between measured
hearing loss and self-reported hearing
difculties was consistent with previous
ndings.
11-14
However, the discrepancy
in the CHMS data was wider than what
was observed in studies that used a
single question (“Do you feel you have
a hearing loss?”), the Hearing Handicap
Inventory for the Elderly-Screening
(HHIE-S) tool, or questions about
increased television volume.
11,12,28,29
The
wide disparities in the present study
may be due to the hearing questions
that comprise the HUI3 or to differing
demographic distributions across studies.
The low self-reported prevalence in all
studies may reect the insidious nature
of hearing loss and the tendency for indi-
viduals to unknowingly compensate and/
or blame background noise for hearing
What is already known
on this subject?
In Canada, national estimates
of the prevalence of hearing loss
have typically been based on self-
reported data.
Self-reports may underestimate the
prevalence of hearing impairment,
especially among older adults and
among people with mild or high-
frequency hearing loss.
Audiometric evaluation of hearing is
important in understanding the extent of
the problem at the population level.
What does this study
add?
The 2012/2013 Canadian Health
Measures Survey collected audiometric
data on a sample of respondents
representative of the adult population in
the 10 provinces.
Fewer than 4% of adults aged 20 to
79 reported difficulties hearing, but
19% (4.6 million) had a measured
hearing loss that affected their ability to
comprehend speech; at ages 70 to 79,
the figure was 65%.
Canadian population-based estimates
of the prevalence of hearing loss are
similar to those reported in the United
States, Great Britain and Australia.
Overall, 12% of adults with a measured
hearing loss used a hearing aid; at
ages 70 to 79, the figure was 24%.
An estimated 13% of Canadian adults
had occluding earwax, and among
older people, the percentage was 21%.
test frequencies.
17
High-frequency
hearing loss impairs the ability to detect
higher-pitched sounds (for example,
doorbell, telephone ringing, kettle whist-
ling in another room) and consonants
such as s and f. This type of hearing loss
affects understanding of speech in noisy
or reverberant environments
17
and makes
it difcult to distinguish between certain
words (sun/fun, sight/ght). Progression
23
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
toward lower speech frequencies (2 to
4 kHz) that are important for hearing
voiceless consonants (t,p,k,s,ch) would
affect hearing some words (sh, cat, sit
tip) and the ability to understand speech
in any situation.
17
Also noteworthy is
the impact of hearing loss on individ-
uals communicating in their non-native
language, for whom even a mild loss is
problematic.
42
This analysis revealed a higher preva-
lence of hearing loss among adults with
lower household income and education.
These results are similar to Swedish
36
and
Australian
32
ndings, and are consistent
with the association between lower socio-
economic status and poor health outcomes
in general. Difculties that lower socio-
economic groups encounter in accessing
health care and treatment
43,44
may result in
conditions that can affect hearing.
A minority—12%—of hearing-im-
paired Canadians used hearing aids. Even
at older ages, the percentage was rela-
tively small: 24%
E
of 70- to 79-year-olds
with four-frequency hearing loss wore
a hearing aid. This was similar to
NHANES ndings (19%) for Americans
aged 70 or older.
10
Reasons for the low rate of hearing aid
use are beyond the scope of this study,
but the health care systems in different
nations may be a factor. Mizutari et al.
45
reported lower hearing aid ownership/
use (7.3%) in Japan where hearing aids
are not covered, compared with countries
where hearing aids are available through
public health insurance (United Kingdom,
France, Denmark, Netherlands) or are
provided with restrictions (Australia).
46,47
In Canada, hearing aid subsidies and eli-
gibility vary by province.
48
According
to Gopinath et al.,
38
the reasons most
commonly cited by older adults for not
obtaining a hearing aid were the cost
and the belief that it was not needed. A
smaller study in Norway (where hearing
aids are covered by public health insur-
ance) found “acknowledgement of need
for hearing aids” and “checkups/access-
Text table 2
Population-based studies: Prevalence of hearing loss above 25 dB (averaged over 0.5, 1, 2, 4 kHz), by age group,
Canada, United States, Great Britain and Austrialia, selected years
Country and data source Years Sample size Age group Ear Prevalence (%)
United States (Agrawal et al., 2008)
30
1999 to 2004 5,742 20 to 69
worse 16.1
bilateral 7.8
unilateral 7.9
HFPTA
31.0
Canada (Canadian Health Measures Survey) 2012/2013 2,651 20 to 69
worse 15.8
HFPTA
31.0
Australia (Wilson et al., 1999)
32
1997 9,027 16 or older
worse 22.2
better 16.6
Great Britain (Davis et al., 1989)
31
1980 to 1986
(3phases)
2,708 17 to 80
worse 26.1
better 16.1
Canada (Canadian Health Measures Survey) 2012/2013 2,972 20 to 79
worse 19.2
bilateral 10.2
unilateral 8.9
HFPTA
35.4
United States (Lin et al., 2011)
10
2005/2006 717 70 or older
better 63.1
bilateral 90.9
unilateral 4.4
Canada (Canadian Health Measures Survey) 2012/2013 321 70 to 79
worse 65.0
bilateral 49.5
unilateral 15.5
high-frequency pure tone average over 3, 4 and 6 kHz
high-frequency pure tone average over 3, 4, 6 and 8 kHz
Sources: 2012/2013 Canadian Health Measures Survey; 1999 to 2004 National Health and Nutrition Examination Survey; 2005/2006 National Health and Nutrition Examination Survey;
References 31 and 32.
ibility to professionals” accounted for
25% and 24%, respectively, of the vari-
ance in hearing aid use. The ndings of
the present study would be enhanced by
information on the frequency of hearing
aid use, associations with income and
cost, and whether hearing aids improved
functional communication.
Occluding earwax, which may
reduce hearing acuity, was found in
13% of adults—double to six times the
rate reported in other population-based
studies.
31,34
The prevalence of earwax
was 21% among 70- to 79-year-old
CHMS participants, somewhat below
percentages reported in previous analyses
of older adults.
49,50
Other research found
that earwax removal improved audio-
metric hearing thresholds for 40% to
75% of older participants.
33,49
Limitations
The results of this analysis should be
interpreted in the context of several
limitations.
24
Health Reports, Vol. 26, no. 7, pp. 18-25, July 2015 • Statistics Canada, Catalogue no. 82-003-X
Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013
Canadian Health Measures Survey • Research Article
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ear” and “better ear” denitions of hearing
loss would have yielded additional infor-
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Conclusion
Results of the 2012/2013 CHMS show
that about one in ve Canadians aged
20 to 79, an estimated 4.6 million adults,
had audiometrically measured hearing
loss. The large disparity between meas-
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... Many aging adults experience some form of hearing problems (Cruickshanks et al. 1998;Feder et al. 2015;Goman and Lin 2016;Helfer et al. 2017). The loss of sensitivity, particularly at high frequencies, comprises the traditional profile of 'age-related hearing loss' and is commonly associated with impairments of the auditory periphery, including damage of hair cells, spiral ganglion cells, and the stria vascularis (Gratton and Vázquez 2003;Moore 2007;Bao and Ohlemiller 2010;Schmiedt 2010;Dubno et al. 2013;Plack 2014;Keithley 2020). ...
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TYPE="ORG" OID="af2" CNY="US">Irving B. Harris Graduate School of Public Policy Studies, University of Chicago