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Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years
Abstract
Importance
Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.
Objective
To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.
Design, Setting, Participants
Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.
Exposures
Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.
Main Outcomes and Measures
Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.
Results
Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with 18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.
Conclusions and Relevance
Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.
... It has been established that treating hearing loss may effectively reduce the adverse consequences. Nevertheless, the key to early treatment is identifying individuals with hearing loss as soon as possible [20,21]. ...
... The univariate analysis tipped the overweight/obesity, living alone, divorce/widowhood, non-exercise habit, family history of deafness, smoking history, drinking history, hypothyroidism, hyperuricemia history of wearing headphones, history of ototoxic drug was with statistical significance. In combination with the mention rate of risk factors in literature and expert recommendations [21,22,27,29] the above variables were also defined as risk factors. Population surveys [21,22,27,29] suggested that the incidence of hearing loss in male was higher than female. ...
... In combination with the mention rate of risk factors in literature and expert recommendations [21,22,27,29] the above variables were also defined as risk factors. Population surveys [21,22,27,29] suggested that the incidence of hearing loss in male was higher than female. In the study, there was sex difference in the incidence rate, with no statistical significance. ...
Introduction
Currently, age-related hearing loss has become prevalent, awareness and screening rates remain dismally low. Duing to several barriers, as time, personnel training and equipment costs, available hearing screening tools do not adequately meet the need for large-scale hearing detection in community-dwelling older adults. Therefore, an accurate, convenient, and inexpensive hearing screening tool is needed to detect hearing loss, intervene early and reduce the negative consequences and burden of untreated hearing loss on individuals, families and society.
Objectives
The study harnessed "medical big data" and "intelligent medical management" to develop a multi-dimensional screening tool of age-related hearing loss based on WeChat platform.
Methods
The assessment of risk factors was carried out by cross-sectional survey, logistic regression model and receiver operating characteristic (ROC) curve analysis. Combining risk factor assessment, Hearing handicap inventory for the elderly screening version and analog audiometry, the screening software was been developed by JavaScript language and been evaluated and verified.
Results
A total of 401 older adults were included in the cross-sectional study. Logistic regression model (univariate, multivariate) and reference to literature mention rate of risk factors, 18 variables (male, overweight/obesity, living alone, widowed/divorced, history of noise, family history of deafness, non-light diet, no exercising habit, smoking, drinking, headset wearer habit, hypertension, diabetes, hyperlipidemia, cardiovascular and cerebrovascular diseases, hyperuricemia, hypothyroidism, history of ototoxic drug use) were defined as risk factors. The area under the ROC curve (AUC) of the cumulative score of risk factors for early prediction of age-related hearing loss was 0.777 [95% CI (0.721, 0.833)]. The cumulative score threshold of risk factors was defined as 4, to classify the older adults into low-risk (< 4) and high-risk (≥ 4) hearing loss groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the screen tool were 100%, 65.5%, 71.8%, and 100.0%, respectively. The Kappa index was 0.6.
Conclusions
The screening software enabled the closed loop management of real-time data transmission, early warning, management, whole process supervision of the hearing loss and improve self-health belief in it. The software has huge prospects for application as a screening approach for age-related hearing loss.
... N early one third of adults 65 years old and older suffer from hearing loss (1). Adults with hearing loss incur increased medical costs, longer lengths of stay, and have a higher risk of readmission (2). In the ICU, preexisting hearing loss is associated with poorer functional recovery among older ICU survivors (3). ...
... Among older ICU patients, uncorrected sensory impairment may lead to increased delirium, and delirium adversely affects hospital outcomes and subsequent recovery (3,17). Across all levels of care, hearing loss has been associated with an increased risk of hospital readmissions, longer lengths of stay, and decreased satisfaction with healthcare delivery (2,18). Detecting hearing loss among critically ill patients can allow for interventions to improve communication, such as the use of amplifiers, reduction of background noise, or use of whiteboards or tablets (19). ...
OBJECTIVES
Hearing impairment is associated with delirium among ICU patients and a lack of functional recovery among older ICU survivors. We assessed the feasibility of using otoacoustic emissions (OAEs) testing to screen for preexisting hearing loss in the ICU.
DESIGN
Pilot study.
SETTING
Medical ICU at a tertiary medical center.
PATIENTS
All adults (age ≥ 18) and admitted to the medical ICU between November 29, 2021, and December 03, 2021, were eligible for the study.
INTERVENTIONS
OAE is a noninvasive, nonparticipatory tool that is used to screen for hearing loss by detecting intracochlear motion in response to auditory stimulation. The presence or absence of OAE was tested at six frequencies (1 k, 1.5 k, 2 k, 3 k, 4 k hertz).
MEASUREMENTS AND MAIN RESULTS
The primary outcome of feasibility was defined a priori as completion of greater than or equal to 70% of attempted tests. Average time of test completion and barriers or facilitators were also measured as outcomes. A patient passed OAE testing if at least two of six frequencies were detected in at least one ear, suggesting they did not have moderate or severe hearing impairment (that would require an amplifier). Data were also gathered on demographics, delirium, ventilation, sedation, illness severity, and ambient noise. Of 31 patients approached, 23 (74.2%) underwent testing. Eight patients (25.8%) were unable to be tested, most commonly due to elevated ambient noise. Among the 18 patients with complete data, six patients screened positive for hearing loss. The average time for OAE test completion per ear was 152.6 seconds ( sd = 97.6 s).
CONCLUSIONS
OAE testing is a feasible method to screen for hearing loss in the ICU, including in nonparticipatory patients. Identification of hearing loss would facilitate improved communication through interventions such as amplifiers and accommodations. Future studies should evaluate whether identification and treatment of hearing loss in the ICU may reduce delirium and improve post-ICU recovery.
... Essa informação é interpretada pelo cérebro, permitindo a compreensão da fala [1]. Pessoas que apresentam redução da capacidade auditiva a partir de aproximadamente 41 dB de nível de pressão sonora (Sound Pressure Level -SPL), em relação à audição normal (25 dB SPL), são consideradas pessoas com deficiência auditiva [2] [3]. ...
... A redução na capacidade de ouvir, ou perda auditiva, tem sido vista cada vez mais como um problema de saúde de grande importância, uma vez que pode acarretar no isolamento social do indivíduo [4], na perda da autonomia [5], em depressão [6] e até mesmo em disfunções neurocognitivas [2]. ...
... There have been several quantitative studies of ED utilization and care processes among people who are DHH. [26][27][28][29][30][31] Despite the socioeconomic differences among DHH people, this population is at higher risk than non-DHH English speakers of using the ED, 26,27 and DHH ASL-users are at higher risk of longer ED length of stay (LOS). 28,30 Despite the growing quantitative literature in this area, there is a lack of qualitative research focused on ED care for DHH people. ...
... Multiple studies, including one from the parent mixed-methods study, 26 suggest that DHH patients are at higher risk of ED utilization than non-DHH people. 6,27,29 There were no differences between DHH ASL-users and English speakers when compared to non-DHH English speakers with respect to discharge diagnoses 26 or ED triage condition acuity level (using the Emergency Severity Index 52 ). 28 Based on findings from this qualitative study, DHH patients report seeking ED care for issues that they perceive as serious, including ...
Background
Deaf and hard‐of‐hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non‐DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient–provider communication. This qualitative study aimed to describe ED care‐seeking and patient‐centred care perspectives among DHH patients.
Methods
This qualitative study is the second phase of a mixed‐methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non‐DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)‐users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach.
Results
Two themes were developed: (1) DHH patients engage in a complex decision‐making process to determine ED utilization and (2) patient‐centred ED care differs between DHH ASL‐users and DHH English speakers. The first theme describes the social‐behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes.
Conclusions
This study underscores the importance of better understanding, and intervening in, DHH patient ED care‐seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity‐relevant indicator. We also discuss recommendations for emergency medicine.
Patient or Public Contribution
This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co‐authorship are listed in the byline, with others in the acknowledgements. In addition, several academic‐based co‐authors are also deaf or hard of hearing.
... The under identification and limited utilization of hearing technology is highly problematic because inadequately managed hearing loss is associated with many healthcare concerns including poorer healthcare communication [18,19], poorer recall of complex medical information [20], lower cognitive functioning and increased incidence of dementia [21,22], fatigue [23], depression [24], overall poorer health as evidenced by higher incidence of hospital admissions and increased use of healthcare [25,26], as well as increased incidence of falls [27][28][29] and reduced healthcare satisfaction [30,31]. There is significant evidence that hearing technology and rehabilitation can ameliorate these negative effects. ...
Age-related hearing loss is becoming more prevalent as the aging population continues to rise worldwide. Left untreated, hearing loss is a significantly under-reported concern that negatively impacts quality of life including mental health, cognition, and healthcare communication. Since many older adults may not report hearing concerns to their primary physicians, allied healthcare providers (AHPs) have an important role in recognizing communication challenges due to potential hearing loss, screening for hearing issues, and making referrals as needed. Moreover, AHPs may need to address hearing loss, at least temporarily, to provide their services when communication problems are present. The purpose of this study was to examine knowledge and practice patterns of AHPs regarding hearing loss among their patients. Results of a national survey indicated that many AHPs understand the negative implications of unaddressed hearing loss and the importance of hearing screening, but they are unsure of who, when, and how to address it. Consequently, immediate and innovative solutions are offered to AHPs to enhance communication with patients who might have unaddressed hearing loss. Moreover, findings can be used to develop training and policies to ensure that professionals are well positioned to address the complex needs of individuals with unaddressed hearing loss.
... Understanding the associations between HL, ADL/ IADL difficulty, and experience of the consequences of unmet ADL/IADL-related needs is critical given the high prevalence of HL among older adults and its clinical relevance as a potentially modifiable risk factor with low-risk treatment options. Several prior studies have demonstrated that HL, ADL/IADL limitations, and the consequences of unmet ADL/IADL-related needs are each independently associated with increased health care utilization, including increased risk of hospitalization (Brown et al., 2019;DePalma et al., 2013;Greysen et al., 2015;Na et al., 2017;Reed et al., 2019;Reed & Garcia Morales, 2021;Sands et al., 2006;Schiltz et al., 2020;Xu et al., 2012). While the associations between HL and increased health care utilization may be mediated by a multitude of factors, including the mechanisms detailed above, our study findings offer an additional explanation for this previously observed association. ...
Purpose
Experiencing difficulty with activities of daily living (ADLs) and instrumental ADLs (IADLs) and/or the consequences of unmet ADL/IADL-related needs is associated with adverse health-related outcomes. The association of hearing loss (HL) with experiencing the consequences of unmet ADL/IADL-related needs is not well understood. We investigated the associations of HL with experiencing ADL/IADL difficulties and the consequences of unmet ADL/IADL-related needs in older adults.
Method
We investigated cross-sectional associations between audiometric HL, the number of ADL and IADL difficulties, and the number of consequences of unmet ADL/IADL-related needs among adults aged 65 years and older in the National Health and Aging Trends Study.
Results
In 4,724 older adults, 30.5% (n = 1,736) and 30.9% (n = 1,727) had self-reported difficulty with ADLs and IADLs, respectively. Of the 2,289 participants who reported difficulty with at least one ADL/IADL, 14.0% (n = 741) reported experience of at least one consequence of an unmet ADL/IADL-related need. In multivariable ordinal regression analyses, mild (OR = 1.38, 95% CI [1.1, 1.73]) and moderate or greater (OR = 1.57, 95% CI [1.17, 2.1]) HL were associated with higher odds of difficulties with additional ADLs. Moderate or greater HL was associated with higher odds of reporting difficulties with additional IADLs (OR = 1.59, 95% CI [1.19, 2.12]). There was no significant association between HL and higher odds of having additional consequences of unmet needs.
Conclusions
Our results show an association between HL and a higher number of ADL and IADL difficulties. Adults with HL may require increased support to address difficulties with daily activities and prevent experiencing related consequences.
Supplemental Material
https://doi.org/10.23641/asha.28300049
... A systematic review indicates that in the United States, productivity losses and direct medical costs due to hearing impairment range from $1.8 billion to $194 billion and from $3.3 billion to $12.8 billion, respectively [42]. These findings suggest that the use of hearing aids could lead to reduced healthcare expenditures [25,43]. A global analysis by the WHO has shown that the social and economic costs of untreated hearing loss are estimated to be between $750 billion and $790 billion annually [44]. ...
Objectives:
This study evaluated the cost-effectiveness of using hearing aids among individuals aged 50 and older with varying levels of hearing loss in South Korea.
Methods:
A state-transition Markov model was employed to assess the cost-effectiveness of hearing aid utilization from a societal perspective. We simulated a cohort of patients aged 50, tracking their progression through normal, mild, moderate, and severe stages of hearing loss until death or age 80. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year gained was determined using both published and calculated data on the costs and effectiveness of hearing aids.
Results:
The respective ICERs were 10,635 for women. These figures are significantly below the willingness-to-pay (WTP) threshold of $31,721, which corresponds to the per capita gross domestic product in 2020. The probabilities of cost-effectiveness were 83.6% for men and 73.4% for women at this WTP threshold. The lower ICERs observed in men can likely be attributed to the earlier onset of hearing loss and the rapid progression from normal, mild, moderate, and severe stages of hearing loss to death.
Conclusion:
Hearing aids represent a highly cost-effective intervention for adults aged 50 and older in Korea, regardless of the degree of hearing loss, even in mild cases. In light of the rapidly aging population, it would be prudent for government policymakers to consider the costeffectiveness of hearing aids in their decision-making processes.
... 16,17 One of the biggest barriers to receiving hearing health care is access to insurance. 18 While this has been mitigated and dampened by the introduction of direct-toconsumer hearing aid sales, patients need quality information to find the best fit for themselves and to also make sound decisions regarding their hearing health care. ...
Objective To determine the readability and quality of both English and Spanish Web sites for the topic of hearing aids.
Study Design Cross-sectional Web site analysis.
Setting Various online search engines.
Methods The term “hearing aid” was queried across four popular search engines. The first resulted 75 English Web sites and first resulted 75 Spanish Web sites were extracted for data collection. Web sites that met the inclusion criteria were stratified by the presence of a Health on the Net Code (HONCode) certificate. Articles were then compiled to be independently reviewed by experts on hearing aids, using the DISCERN criteria, which allowed assessment of the quality of the Web sites. Readability was assessed by calculating the Flesch Reading Ease Score in English and the Fernandez Huerta Formula in Spanish. Readability and quality were both analyzed, comparing scores to their respective language and cross-comparing.
Results There were 37 English Web sites and 30 Spanish Web sites that met inclusion criteria. When analyzing readability, English Web sites were determined to be significantly more difficult to read (average = 55.37, standard deviation [SD] = 7.73, 95% confidence interval [CI] = 52.9–57.9) than the Spanish Web site counterparts (average = 58.64, SD = 5.26, 95% CI = 56.8–60.5, p = 0.035). For quality, Spanish Web sites (average = 38, SD = 9.7, 95% CI = 34.5–41.5) were determined to be of significantly higher quality than English Web sites (average = 32.16, SD = 10.60, 95% CI = 29.7–34.6). Additionally, there was a significant difference between the non-HONCode English Web sites versus the non-HONCode Spanish Web sites (p = 0.0081), signifying that Spanish non-HONCode certified Web sites were less reliable than non-HONCode certified English Web sites.
Discussion The present study highlights the importance and necessity of providing quality, readable materials to patients seeking information regarding hearing aids. This study shows that both English and Spanish Web sites are written at a level that is much higher than the American Medical Association (AMA)-recommended sixth-grade reading level, and no Web site included in this study fell at or below the AMA-recommended sixth-grade reading level. English and Spanish Web sites also lacked consistency and quality, as evidenced by their wide variability in DISCERN scores. Specifically, Hispanic patients are more likely to suffer long-term consequences of their health care due to low levels of health literacy. It is important to bridge this gap by providing adequate reading materials. It is especially important to provide evidence-based claims that are directly supported by experts in the field.
... This study follows Standards for Reporting Qualitative Study [16] As part of a larger study on the pregnancy experiences and outcomes of DHH women [17][18][19], interviews with 22 DHH English speakers (non-signers) were conducted, and a sample size was chosen based on data saturation [20]. Data collection stopped when no new themes emerged from the data. ...
Objective
Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care.
Design
Qualitative study using thematic analysis.
Setting
Semi‐structured, individual remote, or in‐person interviews in the United States.
Sample
Twenty‐two DHH English speakers (non‐signers) who gave birth in the United States within the past 5 years.
Methods
Semi‐structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted.
Main Outcome Measures
The barriers and facilitators related to a positive perinatal care experience among DHH women.
Results
Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self‐advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences.
Conclusions
Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.
... 8,9 Access to insurance remains one of the foremost barriers in obtaining hearing health care advice. 10 Patients necessitate reliable information to identify optimal preventive measures and make informed decisions regarding their hearing health. Previous research has shown that individuals with lower health literacy are less inclined to seek health care compared to those with higher health literacy levels. ...
Objective
This cross‐sectional website analysis aimed to determine the readability and quality of English and Spanish websites pertaining to the prevention of noise‐induced hearing loss.
Study Design
Cross‐sectional website analysis.
Setting
Various online search engines.
Methods
We queried four popular search engines using the term “noise‐induced hearing loss prevention” to reveal the top 50 English and top 50 Spanish websites for data collection. Websites meeting inclusion criteria were stratified based on the presence of a Health on the Net Code certificate (independent assessment of honesty, reliability, and quality). Websites were then independently reviewed by experts using the DISCERN criteria in order to assess information quality. Readability was calculated using the Flesch reading ease score for English and the Fernandez‐Huerta formula for Spanish websites.
Results
Thirty‐six English websites and 32 Spanish websites met the inclusion criteria. English websites had significantly lower readability (average = 56.34, SD = 11.17) compared to Spanish websites (average = 61.88, SD = 5.33) ( P < .05). Spanish websites (average = 37, SD = 8.47) were also of significantly higher quality than English websites (average = 25.13, SD = 10.11).
Conclusion
This study emphasizes the importance of providing quality and readable materials to patients seeking information about noise‐induced hearing loss prevention. All of the English and Spanish websites reviewed were written at a level higher than the American Medical Association‐recommended sixth‐grade reading level. The study also highlights the need for evidence‐based information online provided by experts in our field.
... Beyond cognitive impairment, age-related hearing loss has been independently associated with negative outcomes across almost every aspect of healthy aging, including falls, depression, social isolation, hospitalization, and increased health-care expenditure. [16][17][18][19][20] In mov- Overall, the ACHIEVE trial was a null trial. There was no statistically significant difference in cognitive decline over 3 years between the group that received the hearing intervention and the group that received the health education control. ...
Alzheimer's disease and related dementias (ADRDs) and age‐related hearing loss are the intersection of two major public health challenges. With age as the primary risk factor for both disease processes, the burden of ADRDs and age‐related hearing loss is growing, and each field maintains significant barriers to broadscale identification and management that is affordable and accessible. With the disproportionate burden of ADRDs among racial and ethnic minority older adults and existing disparities within hearing care, both areas face challenges in achieving equitable access and outcomes across diverse populations. The publication of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial in July 2023 marked a significant moment in the fields of brain and hearing health. The ACHIEVE trial was the first randomized controlled trial to examine whether providing hearing intervention, specifically provision of hearing aids, compared to an education control, would reduce cognitive changes over 3 years. The participants most at risk for cognitive decline, with lower education, lower income, more likely to identify as Black, and have more cardiovascular risk factors, were the participants who benefited most from the hearing intervention and are also the least likely to be represented in research and the least likely to obtain hearing care. With growing evidence of the interconnection between cognitive and sensory health, we have an opportunity to prioritize equity, from purposeful inclusion of diverse participants in trials to influencing the emerging market of over‐the‐counter hearing aids to supporting expanded models of hearing care that reach those who have traditionally gone unserved. No longer can hearing go unrecognized by clinicians, researchers, and advocates for brain health. At the same time, the fields of brain and hearing health must center equity if we are going to meet the needs of diverse older adults in a world in which hearing health matters.
... Hearing loss also causes direct and indirect financial burdens. When untreated, it increases nonauditory health care costs by an estimated 46% (Reed et al., 2019) and is associated with reduced lifetime earnings (Huddle et al., 2017). ...
Purpose
Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program.
Method
Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density–matched case–control study and multiple linear regression analyses.
Results
Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density–matched case–control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times.
Conclusions
Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.
... 18,19 Untreated and undiagnosed hearing loss can lead to reduced quality of life, social isolation, depression, dementia, and significant financial burdens on health systems. [20][21][22][23] Mobile hearing testing, which is readily available and simple to use, provides a valuable means of initially identifying hearing loss in resource-limited environments. As the number of individuals affected by hearing loss continues to grow, the role of mobile testing is likely to become increasingly important. ...
The popularity of mobile devices, combined with advances in electronic design and internet technology, has enabled home-based hearing tests in recent years. The purpose of this article is to highlight the distinctive aspects of pure-tone audiometry performed on a mobile device by means of the Hearing Test app for Android devices. The first version of this app was released a decade ago, and since then the app has been systematically improved, which required addressing many issues common to the majority of mobile apps for hearing testing. The article discusses techniques for mobile device calibration, outlines the testing procedure and how it differs from traditional pure-tone audiometry, explores the potential for bone conduction testing, and provides considerations for interpreting mobile audiometry including test duration and background noise. The article concludes by detailing clinically relevant aspects requiring special attention during testing and interpretation of results which are of substantial value to the hundreds of thousands of active users of the Hearing Test app worldwide, as well as to users of other hearing test apps.
... Early identification and intervention of hearing loss may offer individuals with TS improved quality of life and improved communication with their healthcare team. In general, untreated hearing loss contributes to lower adherence to medical recommendations, higher healthcare costs, and higher risk of hospital readmission compared to patients without hearing loss [10]. ...
Background
Individuals with Turner syndrome (TS, ORPHA 881) experience barriers in communication throughout life as they navigate both early conductive, and progressive sensorineural hearing loss amid other healthcare needs. Hearing loss is self-identified as one of the largest unmet healthcare needs.
Purpose
The purpose of this study was to investigate the impact of treatment for hearing loss on communication confidence and quality of life measures for individuals with TS.
Research design
We employed a prospective cross-sectional study design that included both online survey data and audiometric data for a subset of participants.
Study sample
We recruited 179 adults with TS at the Turner Syndrome Society of the United States (TSSUS) Conference, and through a variety of regional TS organizations’ social media platforms. Audiological data was collected onsite at the conference for a subset of 67 participants; 8 of which who were followed after receiving subsequent treatment with hearing aids.
Data collection and analysis
The online survey design included demographic questions, the Communication Confidence Profile (CCP), and the RAND 36-Item Health Survey 1.0. Audiometric data included tympanometry, puretone air, and puretone bone conduction thresholds. Descriptive statistics, parametric, and non-parametric tests were used to analyze both survey and audiometric data.
Results
74% of participants had a self-reported diagnosis of hearing loss, of which 61% were previously recommended amplification. Only 38% of participants reported using hearing aids. For those participants who wore hearing aids, Total CCP Score, ‘Confidence in Ability to Hear Under Various Conditions’, and ‘Energy/Vitality’ metrics were significantly greater than those with untreated hearing loss warranting a hearing aid. Collectively, Total CCP Score and ‘Confidence in Ability to Hear Under Various Conditions’ increased significantly when participants were fit with hearing aids.
Conclusion
The results support previous data where hearing loss is a self-identified healthcare concern among women with Turner syndrome, yet many fail to receive appropriate hearing evaluation or treatment. Additionally, the use of hearing aids may improve communication confidence and quality of life in women with Turner syndrome. Furthermore, this study confirms the need for long-term audiological care and monitoring in women with Turner syndrome.
... Examining the connection between hearing, vision, and dual sensory impairment and social isolation may yield informative insights for addressing social isolation. Given older adults, and particularly older adults with sensory loss, have more frequent health care encounters [21,22], there is significant opportunity within the health care system for identifying and mitigating social isolation with potential beneficial effects on associated downstream health and mental health outcomes. ...
Background
Little is known about the long-term impact of hearing and vision impairment on social isolation. This study quantifies the association between hearing, vision, and concurrent hearing and vision impairment (dual sensory impairment) and social isolation over 8 years among older adults.
Methods
Data were from the National Health and Aging Trends Study (NHATS), a cohort study (2011 – 2019) of U.S. Medicare beneficiaries aged 65 years and older. Social isolation was measured by a binary indicator incorporating four domains: living arrangement, core discussion network size, religious attendance, and social participation. Hearing, vision, and dual sensory impairments were measured by self-report and modeled categorically (no impairment [ref.], hearing impairment only, vision impairment only, dual sensory impairment). Associations between sensory impairments and odds of social isolation over 8 years were assessed using multivariate generalized logistic mixed models and adjusted for demographic and health characteristics.
Results
Among 5,552 participants, 18.9% self-reported hearing impairment, 4.8% self-reported vision impairment, and 2.3% self-reported dual sensory impairment. Over 8 years, hearing impairment only was associated with 28% greater odds of social isolation. Participants with hearing impairment only were more likely to live alone and have limited social participation.
Conclusion
Greater clinical awareness of hearing impairment as a risk factor for social isolation can increase opportunities to identify and aid older adults who may benefit from resources and interventions to increase social connection and mitigate social isolation.
... We found that the number of patients diagnosed with sensorineural hearing loss who continued to visit the clinic year after year increased significantly and steadily. Studies have shown that only 8% of cases treated for sensorineural hearing loss improved [20]. In this study, I think it is the result of a well-reflected study that sensory neurotic hearing loss accounts for the most types of Gap hearing loss. ...
Objectives
Hearing loss is the inability to hear speech or sounds well, owing to a number of causes. This study aimed to simultaneously determine the prevalence, incidence, and the Gap between them in hearing loss in South Korean patients at the same point in time as well as to identify patients who have not recovered from hearing loss.
Methods
We examined the prevalence and incidence of patients diagnosed with hearing loss in the National Health Insurance Service database over an 11-year period from 2010 to 2020. The difference between the prevalence and the incidence was defined in this study as the term "Gap". Gap is the number of patients converted into the number of patients per 100,000 people by subtracting the incidence from the prevalence. Clinical characteristics such as sex and age per 100,000 individuals were examined.
Results
As of 2020, the domestic prevalence obtained in this study was 1.84%, increasing annually, and the prevalence increased with age to 4.10% among those over 60. The domestic incidence was 1.57%, increasing annually, and the incidence increased with age to 3.36% for those over 60s. The Gap was 0.27%, showing a steady increase from 2011 to 2020 with a corresponding increase in insurance benefit expenses.
Conclusion
To fully understand the burden of hearing loss and develop effective prevention and treatment strategies, it is important to measure the Gap between its prevalence and incidence. This Gap means a lot because hearing loss is an irreversible disease. Gap represents patients who have already been diagnosed with hearing loss and are being diagnosed every year, indicating that the number of patients who do not recover is increasing. In other words, the increase in Gap meant that there were many patients who constantly visited the hospital for diagnosis of hearing loss.
... Individuals with hearing di cultly(HD) face challenges that may lead to higher reliance on emergency department(ED) care. 1 Although previous studies have examined associations of HD with negative health care utilization outcomes, including increased hospitalizations,higher health care costs, emergency department visits, and di culty accessing health care, less is known about ED use during the COVID-19 pandemic period. [2][3][4][5] Post-acute COVID-19 is a syndrome characterized by the persistence of clinical symptoms beyond four weeks from the onset of acute symptoms,and can persist for at least 12 months. 6 The COVID-19 epidemics in the past caused a considerable burden on the local healthcare systems in the areas where they occurred because the people who recovered from these viral illnesses had persistent symptoms of extreme fatigue,persistent shortness of breath, a decreased quality of life (QOL), and behavioral health issues. ...
Objective
Hearing difficultly(HD) may be associated with an increased risk for emergency department(ED) visits among older adults.The COVID-19 pandemic has negatively affected adult healthy status. However, less is known about the characteristics of ED visits in older adults with hearing difficulty during the COVID-19 pandemic.this study is to assess the association between self-reported HD severity and ED visits during the COVID-19 pandemic.
Methods
This population-based cross-sectional study used self-reported hearing difficulty and characteristics for respondents aged 65 years or older from 3 cycles of National Health Interview Survey from 2020 to 2022. Data were analyzed from February 23, 2023, to March 22, 2023.The main outcome was respondent-reported emergency department visits(including visited hospital emergency room and/or visited urgent care ) in the past 12 months. Generalized linear models were used to adjust for differences between the groups, and the associations between HD status and visit characteristics were expressed as rate ratios.
Results
The COVID19 Pandemic period, common reasons for HD visits included chronic pain (82.8%),fragile (77.9%),trouble falling/staying asleep (73.2%),hypertension (67.4%) ,and arthritis (60.1%)which were 1.5 times as likely compared with non-SRHD visits ( chronic pain: adjusted rate ratio [ARR], 1.64[95% CI, 1.44 to 1.93]; fragile: ARR, 1.57 [95% CI, 1.16 to 1.87]; trouble falling/staying asleep:ARR, 1.51[95% CI, 1.21 to 1.82]; hypertension: ARR, 1.01[95% CI, 0.92 to 1.23]; arthritis:ARR, 1.39[95% CI, 1.31 to 1.57]
Conclusions
In this cross-sectional study,older adults with hearing impairments were more likely to seek emergency visits for chronic pain,fragile,trouble falling/staying asleep, hypertension and arthritis than those without hearing impairments during the COVID-19 pandemic.
... There is a consistent trend in the literature that individuals with hearing loss have higher health resource utilization and, as such, higher medical costs (Deardorff et al., 2019;Reed et al., 2019;Wells et al., 2019). We observed more falls over 3 years among PACE participants with hearing loss at baseline. ...
Purpose
The purpose of this study was to explore the relationships between hearing loss, cognitive status, and a range of health outcomes over a period of 2 years in a sample of older adults who are enrolled in Program of All-Inclusive Care for the Elderly, which is a Medicare/Medicaid beneficiary program for individuals who are nursing home eligible but living in the community at time of enrollment.
Method
The sample (N = 144) includes a diverse (47% White/non-Hispanic, 35% Black/African American, and 16% Latin/Hispanic) group of adults ranging from 55 to 93 years old. We used medical chart data to measure respondents' cognitive and health status, including chronic conditions and hospital use. Hearing status was measured once at the beginning of the 2-year review period. We used logistic regression and negative binomial hurdle models for analyses. We used latent class analysis (LCA) to explore the extent to which respondents cluster into a set of “health profiles” characterized by their hearing, cognitive status, and health conditions.
Results
We found that hearing loss is weakly associated with heart disease and diabetes and associated with cerebrovascular disease and falls; cognitive impairment is also associated with cerebrovascular disease and the number of falls. LCA indicates that respondents cluster into a variety of health profiles with a consistent pairing of hearing loss and depression.
Conclusions
The results are largely consistent with associations reported in epidemiological studies that include age-related hearing loss. Of particular interest in this study is the LCA that suggested that all of the profiles associated with a high likelihood of hearing loss included a high risk of depression. The co-occurrence of these two factors highlights the need to identify and treat hearing loss in older adults, especially as part of the treatment plan for individuals with depressive symptoms.
... Recent studies have shown that individuals with communication and hearing barriers have lower treatment adherence, increased medical costs, and hospital readmissions. 16,17 If health care systems hope to achieve equitable access and use of telehealth services, identifying and engaging those with functional limitations to engaging in such care will be key. ...
Introduction
The Veterans Health Administration (VHA) distributes video-enabled tablets to individuals with barriers to accessing care. Data suggests that many tablets are under-used. We surveyed Veterans who received a tablet to identify barriers that are associated with lower use, and evaluated the impact of a telephone-based orientation call on reported barriers and future video use.
Methods
We used a national survey to assess for the presence of 13 barriers to accessing video-based care, and then calculated the prevalence of the barriers stratified by video care utilization in the 6 months after survey administration. We used multivariable modeling to examine the association between each barrier and video-based care use and evaluated whether a telephone-based orientation modified this association.
Results
The most prevalent patient-reported barriers to video-based care were not knowing how to schedule a visit, prior video care being rescheduled/canceled, and past problems using video care. Following adjustment, individuals who reported vision or hearing difficulties and those who reported that video care does not provide high-quality care had a 19% and 12% lower probability of future video care use, respectively. Individuals who reported no interest in video care, or did not know how to schedule a video care visit, had an 11% and 10% lower probability of being a video care user, respectively. A telephone-based orientation following device receipt did not improve the probability of being a video care user.
Discussion
Barriers to engaging in virtual care persist despite access to video-enabled devices. Targeted interventions beyond telephone-based orientation are needed to facilitate adoption and engagement in video visits.
... 8 In addition to dementia risk and links to dementia biomarkers, HL is associated with higher rates of hospitalization/rehospitalization, with longer hospital stays, frailty, depression, loneliness, social isolation, and behavioral symptoms in long-term care. [10][11][12][13][14][15][16] Despite the prevalence and negative consequences of HL, treatment uptake is surprisingly low at 17%. 17 Among adults over 70 that could benefit from using a hearing aid to treat HL, less than 1/3 have done so. 18 Behavioral symptoms are almost ubiquitous in dementia, and neuropsychiatric symptoms (NPS) are part of core clinical criteria. ...
INTRODUCTION
Hearing loss (HL) and mild behavioral impairment (MBI) are non‐cognitive markers of dementia. This study investigated the relationship between hearing and MBI and explored the influence of hearing aid use on the treatment of hearing loss, both cross‐sectionally and longitudinally.
METHODS
Data were analyzed from National Alzheimer's Coordinating Center participants, age ≥50, dementia‐free at baseline, collected between 2005 and 2022. Three self‐report questions were used to generate a three‐level categorical hearing variable: No‐HL, Untreated‐HL, and Treated‐HL. MBI status was derived from the informant‐rated Neuropsychiatric Inventory Questionnaire (NPI‐Q) using a published algorithm. At baseline ( n = 7080), logistic regression was used to examine the association between hearing status (predictor) and the presence of global and domain‐specific MBI (outcome), adjusting for age, sex, cognitive diagnosis, and apolipoprotein E4 (APOE4). Cox proportional hazard models with time‐dependent covariates were used to examine the effect of (1) hearing status as exposure on the rate of incident MBI ( n = 5889); and (2) MBI as exposure on the rate of incident HL in those with no HL at baseline ( n = 6252).
RESULTS
Cross‐sectionally, participants with Untreated‐HL were more likely to exhibit global MBI (adjusted odds ratio (aOR) = 1.66, 95% CI: 1.24–2.21) and individual MBI domains of social inappropriateness (aOR = 1.95, 95% CI: 1.06–3.39), affective dysregulation (aOR = 1.71, 95% CI: 1.21–2.38), and impulse dyscontrol (aOR = 1.71, 95% CI: 1.21–2.38), compared to those with No‐HL. Participants with Treated‐HL (i.e., hearing aid use) did not differ from No‐HL for odds of global or most MBI domains, except for impulse dyscontrol (aOR = 1.38, 95% CI: 1.05–1.81). Longitudinally, we found relationships between Treated‐HL and incident MBI (adjusted hazard ratio (aHR) = 1.29, 95% CI: 1.01–1.63) and between MBI and incident Untreated‐HL (aHR = 1.51, 95% CI: 1.19–1.94).
DISCUSSION
Our cross‐sectional results support that hearing aid use is associated with lower odds of concurrent global MBI in dementia‐free participants. Longitudinally, relationships were found between MBI and HL. The severity of HL was not assessed, however, and may require further exploration.
Highlights
Hearing Loss (HL) and mild behavioral impairment (MBI) are markers of dementia
Cross‐sectionally: Untreated‐HL was associated with global MBI burden, but
HL treated with hearing aids was not
We found associations between MBI and incident Untreated‐HL
... 16 Relatedly, individuals with hearing loss experience increased health care utilization and higher health-related costs compared to individuals without hearing loss. 17 These associations may be mediated, in part, by poorer communication that often occurs between health care providers and patients with hearing difficulty. 9 Previous studies that examined the association between hearing and satisfaction with health care revealed that those with hearing loss had a higher likelihood of dissatisfaction with health care. ...
Objective
Hearing loss may negatively impact satisfaction with health care via patient‐provider communication barriers and may be amenable to hearing care treatment.
Study Design
Cross‐sectional.
Setting
National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles.
Methods
Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self‐report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use.
Results
Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18‐1.23), a little trouble (PRR = 1.27, 95% CI, 1.23‐1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24‐1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18‐1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78‐0.88) compared to nonusers.
Conclusion
Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient‐provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.
... 21 Despite the availability of treatment methods, 50% of the general practitioners have a negative attitude toward diagnosing and treating age-related hearing loss. 16,22 Typically, older adults are unaware of hearing loss or reluctant to reveal it, but if inquired by the general practitioner, patients are more likely to follow their https://doi.org/10.2147/CIA.S423822 ...
Background:
There is a high incidence rate of age-related hearing loss. Severe hearing loss may increase the prevalence of mental illness, cognitive impairment, and even the risk of all-cause death.
Purpose:
Construction of the three-level and two-stage screening mode for age-related hearing loss of the community and to evaluate its effectiveness.
Materials and methods:
A total of 401 participants (aged 60 years or older) from five typical communities were enrolled in the study. The risk factors assessment of age-related hearing loss was completed by using a cross-sectional survey and receiver operating characteristic (ROC) curve. Multiple screening method was adopted and verified by serial and parallel tests, respectively. Based on research data, incorporate risk factors assessment, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-s) and pure tone audiometry (PTA) were used to construct the screening mode.
Results:
Multiple screening series testing and multiple screening parallel testing, including risk factors assessment, HHIE-s, and PTA, were used for verification: the sensitivity, specificity, and Kappa index were 70.5% and 9.2%, 95.0% and 71.6%, 0.26 and 0.63, respectively. Finally, the three-level and two-stage screening mode for age-related hearing loss was established. "Three-level" was defined as the risk factors assessment/HHIE-s (high-risk population), PTA (suspect population), and comprehensive hearing loss assessment (confirmed population). "Two-stage" was defined as the population screening by general practitioner in the community and target screening by otolaryngologist of the tertiary hospitals.
Conclusion:
The three-level and two-stage screening mode for age-related hearing loss consists of the following framework: from population screening to target screening, from suspicious diagnosis to accurate diagnosis, from primary health care to tertiary hospitals. The study objective is to structure a new secondary prevention and treatment mode for age-related hearing loss with primary health care as the core, so as to help the front-end management of healthy aging.
... 10 People with sensory loss are also less likely than those without sensory loss to have timely access to preventive care, while experiencing higher mortality rates, poorer mental and physical health, and longer hospitalization stays. 9,11 For example, Reed et al 12 found that individuals with untreated hearing loss, compared with those without hearing loss, accounted for 46% higher health care costs and 17% higher risk of emergency department visits. Moreover, Genther et al 13 observed that the hospitalization risks for those with mild and moderate hearing loss was 16% and 21% greater, respectively, when compared with hospitalizations among those without hearing loss. ...
Objective:
To evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls.
Patients and methods:
Using 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level.
Results:
People with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls.
Conclusion:
People with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.
... Because of difficulties in communication, they are often isolated from friends and family, which reduces their cognitive ability and subjective well-being (8,10). Further, hearing impairment may increase healthcare and other related costs (11). A systematic review in the United States revealed that the direct medical costs due to hearing impairment ranged from $3.3 billion to $12.8 billion (12). ...
Objective:
To assess the cost-effectiveness of hearing aid interventions to middle-aged and older adults in rural China.
Study design:
Randomized controlled trial.
Setting:
Community centers.
Patients:
A total of 385 subjects 45 years and older with moderate or above hearing loss participated in the trial, of which 150 were in the treatment group and 235 in the control group.
Intervention:
Participants were randomly assigned to the treatment group prescribing with hearing aids or to the control group with no intervention.
Main outcome and measures:
The incremental cost-effectiveness ratio was calculated by comparing the treatment group with the control group.
Results:
Assuming that the average life span of hearing aids is N years, the cost of the hearing aid intervention included the annual purchase cost of 10,000/N yuan, the annual maintenance cost of 41.48 yuan. However, the intervention led to annual healthcare costs of 243.34 yuan saved. The effectiveness of wearing a hearing aid included an increase of 0.017 quality-adjusted life years. It can be calculated that if N > 6.87, the intervention is very cost-effective; if 2.52 < N < 6.87, the increased cost-effectiveness of the intervention is acceptable; if N < 2.52, the intervention is not cost-effective.
Conclusion:
In general, the average life span of hearing aids is between 3 and 7 years, so hearing aid interventions can be considered cost-effective with high probability. Our results can provide critical reference for policy makers to increase accessibility and affordability of hearing aids.
Background
Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.
Objectives
To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.
Research Design and Subjects
This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.
Exposures and Outcomes
The exposure, recognition of hearing loss, was constructed using participants’ self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.
Results
Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26–4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00–4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.
Conclusions
In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.
Purpose
Hearing loss (HL) is a leading cause of disability worldwide, but its health-related costs have been incompletely studied. Our objective was to examine the association between HL and direct health care costs and identify subgroups in which costs associated with HL are especially high.
Method
This was a retrospective population-based cohort study of adults treated in a universal health care system between April 2008 and March 2019. HL was identified using administrative health data. We estimate health care costs in 2023 Canadian dollars, including costs for hospitalization, provider claims, ambulatory care visits, prescription medications, and long-term care (LTC).
Results
Of 4,424,632 participants, 146,644 (3.3%) had HL. Participants with HL were older (Mdn = 55 years [interquartile range: 43–68] vs. 35 years [24–50]) and had more comorbidities (1 [0–2] vs. 0 [0–1]) at baseline than participants without, whereas the likelihood of female sex, rural residence, and material deprivation were similar between groups with and without HL. Over median follow-up of 11.0 years, total age–sex adjusted annual health costs and each of its component costs were significantly higher in participants with HL compared to those without (annual total costs: 6,778, 4,716, 95% CI [4,729, 4,763]). After full adjustment (a maximum of 29 comorbidities), annual costs remained significantly higher in participants with HL overall and for certain subcomponents (provider claims, ambulatory visits, and medications), whereas adjusted costs of hospitalization and LTC were lower among people with HL. The magnitude of the incremental costs among participants with HL was most pronounced for younger participants, men, or those with less comorbidity. Total projected annual direct health costs for Alberta residents with HL were 125 million (95% CI [116, 135 million]) was attributable to HL specifically.
Conclusions
Compared to those without HL, health costs were markedly higher among participants with HL, partially due to a higher burden of comorbidity. The relatively high population attributable costs of HL suggest that better prevention, recognition, and management of this condition could yield substantial economic benefits.
Supplemental Material
https://doi.org/10.23641/asha.27353439
COVID Long Haul (CLH) is an emerging chronic illness for which the healthcare system continues to seek a common understanding of symptoms, diagnosis, and treatment. CLH experiences can differ drastically, necessitating personalized care plans. Because patients interact with different clinicians during their CLH journey, it becomes important to ensure interoperability and understand clinical relevance of different data that can support clinicians in making appropriate recommendations. We conducted qualitative research where we interviewed 13 patients, conducted a focus group with 8 clinicians, and analyzed care plan follow-up records. We report patient and clinician expectations from and interactions with clinic data. We uncover logistical challenges, personal contexts, and health barriers impacting patient compliance. As researchers embedded in the clinical system, we identify the potential of using multiple patient data streams to support personalized treatment and clinical decisions. We discuss technology design opportunities and provide actionable recommendations for improving clinical workflows and cross-provider collaboration.
Objective
Estimate the prevalence of hearing loss and hearing assistance device use among older adults in the United States, and assess for associations with select social determinants of health (SDOH).
Study Design
Cross-sectional US population-based study using National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 (pre-pandemic) data.
Setting
Non-institutionalized civilian adult US population.
Methods
US adults aged ≥70 years who completed NHANES audiometry exams were included. Sample weights were applied to provide nationally representative prevalence estimates of hearing loss and hearing assistance device use. Logistic regression analyses assessed associations between SDOH and both hearing loss and hearing assistance device use.
Results
The overall prevalence of hearing loss was 73.7%. Among those with nonprofound hearing loss, the prevalence of hearing assistance device use was 31.3%. Older individuals (odds ratio [OR], 6.3 [3.668–10.694] comparing ages 80+ versus 70–74 yr) and with lower education (OR, 3.8 [1.455–9.766] comparing <ninth grade versus college graduates or above) experienced a significantly elevated prevalence of hearing loss, whereas females (OR, 0.5 [0.326–0.754] versus males) and Blacks (0.5 [0.295–0.841] versus non-Hispanic Whites) had lower prevalence. Although older individuals with hearing loss had a higher prevalence of hearing assistance device use (OR, 2.1 [1.294–3.553] comparing ages 80+ to 70–74 yr), individuals of Black and other Hispanic races had a significantly lower prevalence of hearing assistance device use than non-Hispanic Whites (OR, 0.4 [0.188–0.671]; OR 0.1 [0.012–0.459], respectively), and those with no health insurance had higher prevalence of use than those who were insured (OR, 4.8 [1.307–17.371]).
Conclusion
The prevalence of hearing loss among older adults in the United States remains roughly stable compared with previous population-based estimates, whereas the prevalence of hearing assistance device use is slightly increased. Population-level disparities exist both in the prevalence of hearing loss and hearing assistance device use across SDOH.
The standard of reference for diagnosing and characterizing hearing loss is audiologic testing. The results of audiologic testing inform the imaging algorithm and the differential diagnosis for the underlying cause. Pure-tone audiometry tests the ability to hear tones across different frequencies, and the results are displayed as an audiogram. Tympanometry measures tympanic membrane compliance as a function of pressure to generate a tympanogram. Acoustic reflex testing helps differentiate third window lesions from other causes of conductive hearing loss. Clinical and audiologic assessment of sensorineural hearing loss helps in differentiating cochlear from retrocochlear causes. Symmetrical sensorineural hearing loss is typical of cochlear disease. Asymmetry increases the likelihood of a retrocochlear lesion, the most common of which among adults is vestibular schwannoma. Unlike patients with sensorineural hearing loss, who commonly have normal imaging studies, patients with conductive hearing loss are expected to have abnormal temporal bone CT studies. By incorporating the results of audiologic testing into their evaluation, radiologists can perform a more informed and more intentional search for the structural cause of hearing loss. The authors describe several audiogram configurations that suggest specific underlying mechanisms of conductive hearing loss. By providing a practical and accessible summary of the basics of audiologic testing, the authors empower the radiologist to leverage relevant clinical information and audiologic test results to interpret temporal bone imaging more confidently and more accurately, particularly temporal bone CT in the setting of conductive hearing loss. ©RSNA, 2024.
Purpose
Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions.
Method
This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey.
Results
Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions.
Conclusion
Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [ Journal of Gerontological Nursing, xx (xx), xx–xx.]
Unethical marketing practices in the hearing aid industry exploit vulnerable populations, hinder informed decision-making, and damage the industry's reputation. This review examines these concerns from global and Indian perspectives, emphasizing the need for ethical practices. It finds that misleading claims, aggressive tactics, lack of transparency, and insufficient risk information pose significant challenges. Addressing these concerns requires strengthening ethical guidelines, promoting transparency, empowering consumers, and fostering collaboration among stakeholders. Ethical considerations are paramount in ensuring equitable access to quality hearing care and empowering individuals to make informed decisions.
Objective: Current clinical assessments for Hearing Loss (HL) are often limited to controlled laboratory settings in which a narrow spectrum of hearing difficulties can be assessed. A majority of the daily life challenges caused by HL cannot be measured in clinical methodologies. To screen the individuals' needs and limitations, a questionnaire named the HEAR-COMMAND tool was developed and qualitatively validated through an international collaboration, aligning with the World Health Organization's International Classification of Functioning, Disability, and Health Framework (ICF) Core Sets for Hearing Loss. The tool empowers healthcare professionals (HCPs) to integrate the ICF framework into patient assessments and patient-reported outcomes (PRO) in clinical and non-clinical settings. The aim is to provide a general foundation and starting point for future applications in various areas including ENT and hearing acoustics. The outcome can be employed to define and support rehabilitation in an evidence-based manner. This article presents the validation and research outcomes of using the tool for individuals with mild to moderately severe HL in contrast to normal-hearing individuals.
Design: Using a cross-sectional multicenter study, the tool was distributed among 215 participants in Germany, the USA, and Egypt, filled in German, English, or Arabic. Three outcome scores and the corresponding disability degree were defined: hearing-related, non-hearing-related, and speech-perception scores. The content and construct validation were conducted, and the tool's internal consistency was assessed.
Results: The extracted constructs included “Auditory processing functionality”, “Sound quality compatibility”, “Listening and communication functionality”, “Interpersonal interaction functionality and infrastructure accessibility”, “Social determinants and infrastructure compatibility”, “Other sensory integration functionality”, and “Cognitive functionality”. Regarding content validity, it was demonstrated that normal-hearing participants differed significantly from individuals with HL in the hearing-related and speech-perception scores. The reliability assessment showed a high internal consistency (Cronbach's alpha = 0.9).
Conclusion: The outcome demonstrated the HEAR-COMMAND tool's high content and construct validity. The tool can effectively represent the patient's perspective of HL and hearing-related functioning and enhance the effectiveness of the treatment plans and rehabilitation. The broad range of targeted concepts provides a unique overview of daily life hearing difficulties and their impact on the patient's functioning and quality of life.
Hearing difficulty (HD) may be associated with an increased frequency of emergency department (ED) visits among older adults. The COVID-19 pandemic has adversely affected the health of older adults. However, less is known about the characteristics of ED visits by older adults with HD during the pandemic. This study examines the association between self-reported HD severity and ED visits during the pandemic. This population-based cross-sectional study used self-reported data on HD and the characteristics of respondents aged 65 years or older from three cycles of the National Health Interview Survey from 2020 to 2022. Data were analysed from February 23, 2023, to March 22, 2023. The primary outcome was self-reported ED visits in the past 12 months. This study employed generalised linear models to examine the relationship between ED visits (dependent variable) and HD in older adults, and the effect sizes were expressed as rate ratios. Key independent variables included the reasons for ED visit. Covariates such as demographic characteristics and socio-economic status were controlled for to account for potential confounding effects. During the pandemic, older adults with HD commonly visited the ED because of chronic pain (82.8%), frailty (77.9%), trouble falling/staying asleep (73.2%), hypertension (67.4%), and arthritis (60.1%), all of which were 1.5-times more likely in these adults than in those with normal hearing (chronic pain: adjusted rate ratio [ARR], 1.64 [95% CI 1.44–1.93]; frailty: ARR, 1.57 [95% CI 1.16–1.87]; trouble falling/staying asleep: ARR, 1.51 [95% CI 1.21–1.82]; hypertension: ARR, 1.01 [95% CI 0.92–1.23]; arthritis: ARR, 1.39 [95% CI 1.31–1.57]. Older adults with HD were more likely to visit the ED for chronic pain, frailty, trouble falling/staying asleep, hypertension, and arthritis than those with normal hearing during the COVID-19 pandemic. Our findings will be help for healthcare providers to be aware of these potential barriers and to implement strategies to ensure that patients with hearing difficulties can access necessary emergency care effectively.
Background and Objectives
Patient portals are secure online platforms that allow patients to perform electronic health management tasks and engage in bidirectional information exchange with their care team. Some health systems administer Medicare Annual Wellness Visit (AWV) health risk assessments through the patient portal. Scalable opportunities from portal-based administration of risk assessments are not well understood. Our objective is 2-fold—to understand who receives vs misses an AWV and health risk assessment and explore who might be missed with portal-based administration.
Research Design and Methods
This is an observational study of electronic medical record and patient portal data (10/03/2021–10/02/2022) for 12 756 primary care patients 66+ years from a large academic health system.
Results
Two-thirds (n = 8420) of older primary care patients incurred an AWV; 81.0% of whom were active portal users. Older adults who were active portal users were more likely to incur AWV than those who were not, though portal use was high in both groups (81.0% with AWV vs 76.8% without; p < .001). Frequently affirmative health risk assessment categories included falls/balance concerns (44.2%), lack of a documented advanced directive (42.3%), sedentary behaviors (39.9%), and incontinence (35.1%). Mean number of portal messages over the 12-month observation period varied from 7.2 among older adults affirmative responses to concerns about safety at home to 13.8 for older adults who reported difficulty completing activities of daily living. Portal messaging varied more than 2-fold across affirmative health risk categories and were marginally higher with greater number affirmative (mean = 13.8 messages/year no risks; 19.6 messages/year 10+ risks).
Discussion and Implications
Most older adults were active portal users—a group more likely to have incurred a billed AWV. Efforts to integrate AWV risk assessments in the patient portal may streamline administration and scalability for dissemination of tailored electronically mediated preventive care but must attend to equity issues.
Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate.
Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey–Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022.
Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19–64 years) increased from 0.3% to 4.6%.
Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults.
Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. ( Am J Public Health. 2024;114(4):407–414. https://doi.org/10.2105/AJPH.2023.307551 )
To evaluate the correlation between thallium and diabetes risk among participants with hearing loss. This retrospective cohort study extracted related data such as demographic characteristics, lifestyle factors, and laboratory findings from the National Health and Nutrition Examination Survey (NHANES) database (2013-2018). Logistic regression analysis and interaction analysis were adopted to analyze the correlation between thallium and diabetes risk among patients with hearing loss. Then, the restricted cubic spline was employed to assess the nonlinear relationship between thallium and diabetes risk. The receiver operating characteristic curve and decision curve analysis were used to assess the predictive values of 3 multivariate models with or without thallium for diabetes risk. The Delong test was adopted to assess the significant change of the area under the curves (AUCs) upon thallium addition. A total of 425 participants with hearing loss were enrolled in the study: without diabetes group (n = 316) and diabetes group (n = 109). Patients with hearing loss in the diabetes group had significantly lower thallium (P < .05). The thallium was an independent predictor for diabetes risk after adjusting various covariates (P < .05). The restricted cubic spline (RCS) result showed that there was a linear correlation between thallium and diabetes risk (P nonlinear > .05). Finally, the receiver operating characteristic and decision curve analysis results revealed that adding thallium to the models slightly increased the performance in predicting diabetes risk but without significance in AUC change. Thallium was an independent predictor of diabetes risk among patients with hearing loss. The addition of thallium might help improve the predictive ability of models for risk reclassification. However, the conclusions should be verified in our cohort in the future due to the limitations inherent in the NHANES database.
In primary‐care‐centric models of care provision, specialist co‐location with primary care physicians (PCPs) can potentially improve care coordination and continuity. This study asks whether the co‐location of specialists with referring PCPs can reinforce racial, ethnic, and class inequities in spatial access to care. Given a US healthcare policy context wherein audiologist services are only reimbursed if they are medical practitioner‐referred, audiologists are hypothesized to co‐locate with PCPs. Using spatial cluster analysis and spatial regression approaches, this study quantifies the tendency for PCPs and audiologists to co‐locate and analyzes the consequences for spatial access disparities in the Chicago, Illinois metropolitan region. Audiologists and PCPs co‐cluster significantly across Chicagoland. The spatial lag model confirms racial, ethnic, and class disparities in network travel distance to audiology services in the core counties of the region. The results suggest that, for audiology services, health policies and the resultant interdependence across the hierarchy of care manifest spatially, possibly reinforcing service access disparities within segregated city regions.
Objective(s)
Despite undergoing thorough cochlear implant (CI) candidacy evaluation and counseling, some patients ultimately elect against implantation. This study sought to identify patient‐related and socioeconomic factors predicting CI deferral.
Methods
A retrospective study of adult (≥18 years old) CI candidates presenting between 2007 and 2021 at a tertiary academic CI center was performed. The primary outcome was device implantation. Data collected included age, gender, hearing status, race, zip code of residence, median family income (MFI), distance traveled from the CI center, marital status, employment status, and insurance status. Multivariable binary logistic regression was performed to identify predictors of implantation.
Results
A total of 200 patients qualifying for CI were included, encompassing 77 adults deferring surgery (CI‐deferred) and 123 consecutive adults electing for surgery (CI‐pursued). Age, gender, hearing status, insurance type, employment status, distance from the implant center, and MFI were comparable between the groups ( p > 0.05). Compared to CI‐pursued patients, CI‐deferred patients were more likely to be non‐Caucasian (24.7% vs. 9.8%, p = 0.015) and unmarried (55.8% vs. 38.2%, p = 0.015). On multivariable logistic regression, older age (OR 0.981, 0.964–0.998, p = 0.027), African American race (OR 0.227, 0.071–0.726, p = 0.012), and unmarried status (OR 0.505, 0.273–0.935, p = 0.030) were independent predictors of implant deferral.
Conclusion
This study demonstrates that increasing age at evaluation, African American race, and unmarried status are predictors for deferring CI surgery despite being implant candidates. These patients may benefit from increased outreach in the form of counseling, education, and social support prior to undergoing CI surgery.
Level of Evidence
3 – retrospective study with internal control group Laryngoscope , 2023
Objectives
The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care.
Methods
The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector.
Results
There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training.
Conclusion
Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO.
The purpose of this study was to estimate the prevalence of occupational noise exposure and risk factors of occupational noise-induced hearing loss (NIHL) in Hispanic/Latino adults included in the baseline wave of the Hispanic Community Health Study/Study of Latinos collected from 2008-2011. Sequential multiple linear regression modeled the relationship between occupational NIHL (defined as a 3-, 4-, 6-kHz pure-tone average [PTA]) and occupation type, self-reported noise exposure, cardiovascular disease (CVD) risk score, and hearing protective device (HPD) use. The final model controlled for sex, age, and recreational noise exposure. Among 12,851 included participants, approximately 40% (n = 5036) reported occupational noise exposure "Sometimes" (up to 50% of the time); or "Frequently" (75%-100% of the time). In the final fitted model, longest held occupation and CVD risk were associated with poorer hearing. Specifically, those in non-skilled, service, skilled, and military/police/other job categories had between 2.07- and 3.29-dB worse PTA than professional/office workers. Additionally, a shift in CVD risk score category from low to medium associated with a 2.25- and 8.20-dB worse PTA for medium and high CVD risk, respectively. Age and sex were also significantly associated with poorer hearing, such that men presented with 6.08 dB worse PTA than women, and for every one-year increase in age, PTA increased by 0.62 dB (ps < .001). No interactions were seen between noise*sometimes or frequent exposure to other ototoxic agents and PTA (ps = .33 & .92, respectively). Prevalence of occupational noise exposure was high in this cross-sectional investigation of adults from Hispanic/Latino backgrounds. Findings contribute to the extant literature by demonstrating that risk factors for occupational NIHL in adults from varying Hispanic/Latino backgrounds are consistent with those of other previously studied groups.
Objective:
To explore socioeconomic disparities in cochlear implant evaluation (CIE) referrals and cochlear implantation.
Study design:
Retrospective chart review.
Setting:
Tertiary referral academic center.
Methods:
Adult patients (n = 271) with an audiogram performed between 2015 and 2019 with a pure-tone average of at least 60 dB and word recognition score of 60% or less in the better-hearing ear or no word recognition score performed were included to determine if socioeconomic factors influenced the rate of referral to CIE and cochlear implantation.
Results:
There were 122 insured patients referred to CIE where 84 were considered cochlear implant (CI) candidates and 73 were implanted. In multivariate regression analysis, non-English-speaking patients were referred to CIE at lower rates (p < 0.01) than English-speaking patients. Patients who met the CI candidacy criteria with private insurance (p = 0.03) or Medicare with private insurance supplement (p = 0.03) had higher rates of cochlear implantation than those with Medicare or Medicaid. Of the uninsured patients (n = 22), 3 were referred to CIE and 2 were considered CI candidates. No uninsured patients received a CI.
Conclusions:
Primary language spoken was associated with a disparity in rates of CIE referral. Insurance type did influence rate of cochlear implantation once patients completed CIE and were considered CI candidates. Additional research is needed to implement strategies for more inclusive treatment.
Importance:
National prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss.
Objective:
To estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older.
Design, setting, and participants:
In this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022.
Main outcomes and measures:
Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use.
Results:
In this nationally representative sample of 2803 participants (weighted estimate, 33.1 million individuals) aged 71 years or older, 38.3% (95% CI, 35.5%-41.1%) were aged 71 to 74 years, 36.0% (95% CI, 33.1%-38.8%) were aged 75 to 79 years, 13.8% (95% CI, 12.6%-14.9%) were aged 80 to 84 years, 7.9% (95% CI, 7.2%-8.6%) were aged 85 to 89 years, and 4.0% (95% CI, 3.5%-4.6%) were aged 90 years or older; 53.5% (95% CI, 50.9%-56.1%) were female and 46.5% (95% CI, 43.9%-49.1%) were male; and 7.5% (95% CI, 6.2%-8.7%) were Black, 6.5% (95% CI, 4.4%-8.7%) were Hispanic, and 82.7% (95% CI, 79.7%-85.6%) were White. An estimated 65.3% of adults 71 years and older (weighted estimate, 21.5 million individuals) had at least some degree of hearing loss (mild, 37.0% [95% CI, 34.7%-39.4%]; moderate, 24.1% [95% CI, 21.9%-26.4%]; and severe, 4.2% [95% CI, 3.3%-5.3%]). The prevalence was higher among White, male, lower-income, and lower education attainment subpopulations and increased with age, such that 96.2% (95% CI, 93.9%-98.6%) of adults aged 90 years and older had hearing loss. Among those with hearing loss, only 29.2% (weighted estimate, 6.4 million individuals) used hearing aids, with lower estimates among Black and Hispanic individuals and low-income individuals.
Conclusions and relevance:
These findings suggest that bilateral hearing loss is nearly ubiquitous among older US individuals, prevalence and severity increase with age, and hearing aid use is low. Deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology, is warranted.
Objectives: The World Health Organization emphasizes lifelong management of hearing diseases and suggests a state-led management program. In addition, the 'Ear and Hearing Care Situation Analysis Tool ' was produced and distributed so that the state-led management program could be implemented well. Therefore, the purpose of this study is to fill 'Ear and Hearing Care Situation Analysis Tool ', understand the current situation of ear and hearing management in Korea, establish a basis for establishing and improving policies related to hearing diseases, and produce data to report to World Health Organization.
Methods: The 'Ear and Hearing Care Situation Analysis Tool 'consists of a total of two sections, 41 questions in Section 1 and 203 questions in Section 2. Section 1 consists of questions that can evaluate health policies and support services. Section 2 consists of questions to evaluate the services and human resources of the ear and hearing management sector.
Results: Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment could be received, and medication prescriptions could be received without distinction. Workers such as audiologists, language therapists, special education teachers, and sign language interpreters, were specialized because they had well-established guidelines for training.
Conclusion: Overall, the domestic ear and hearing management sector has confirmed that policies and services are well prepared close to advanced countries compared to the current status of countries. It can be reported to World Health Organization to help improve domestic ear and hearing management policies and expand medical services.
Background:
Hearing loss (HL) is a leading cause of disability worldwide, but its clinical consequences and population burden have been incompletely studied.
Methods:
We did a retrospective population-based cohort study of 4,724,646 adults residing in Alberta between April 1, 2004 and March 31, 2019, of whom 152,766 (3.2%) had HL identified using administrative health data. We used administrative data to identify comorbidity and clinical outcomes, including death, myocardial infarction, stroke/transient ischemic attack, depression, dementia, placement in long-term care (LTC), hospitalization, emergency visits, pressure ulcers, adverse drug events and falls. We used Weibull survival models (binary outcomes) and negative binomial models (rate outcomes) to compare the likelihood of outcomes in those with vs without HL. We calculated population-attributable fractions to estimate the number of binary outcomes associated with HL.
Findings:
The age-sex-standardized prevalence of all 31 comorbidities at baseline was higher among participants with HL than those without. Over median follow-up of 14.4 y and after adjustment for potential confounders at baseline, participants with HL had higher rates of days in hospital (rate ratio 1.65, 95% CI 1.39, 1.97), falls (RR 1.72, 95% CI 1.59, 1.86), adverse drug events (RR 1.40, 95% CI 1.35, 1.45), and emergency visits (RR 1.21, 95% CI 1.14, 1.28) compared to those without, and higher adjusted hazards of death, myocardial infarction, stroke/transient ischemic attack, depression, heart failure, dementia, pressure ulcers and LTC placement. The estimated number of people with HL who required new LTC placement annually in Canada was 15,631, of which 1023 were attributable to HL. Corresponding estimates for new dementia among people with HL were 14,959 and 4350, and for stroke/TIA the estimates were 11,582 and 2242.
Interpretation:
HL is common, is often accompanied by substantial comorbidity, and is associated with significant increases in risk for a broad range of adverse clinical outcomes, some of which are potentially preventable. This high population health burden suggests that increased and coordinated investment is needed to improve the care of people with HL.
Funding:
Canadian Institutes of Health Research; David Freeze chair in health services research.
People with impaired hearing or deafness often perceive communication barriers when and participating in their daily lives, such as when contacting primary healthcare, leading to a risk of them using emergency services for less urgent conditions. Therefore, the aim of the present study was to describe the perceptions of individuals with hearing impairments and deafness in relation to the treatment and communication they received from primary healthcare professionals. The study employed a mixed-methods design, and the data comprised questionnaire responses from 101 individuals with hearing impairments or deafness, including 11 open-ended questions, analyzed with conventional content analysis. The study was evaluated using the COREQ checklist and the GRAMMS guidelines to further improve the transparency of the research. The results indicate that healthcare professionals who are responsive, considerate, and respectful regarding communication were perceived among people with hearing impairments or deafness to be professionals. The ideal healthcare encounter for people with hearing impairments or deafness would be where the healthcare professionals could perform sign language, which would allow the healthcare professional to communicate freely. Healthcare professionals need more knowledge about how they can best meet, care for, and communicate with individuals with hearing impairments or deafness.
Dr Postma). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. 1. Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension. 2010;56(3):525-532.
To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined.
We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010.
We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence.
We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient.
The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.
The authors investigate the impact of hearing loss on quality of life in a large population of older adults.
Data are from the 5-year follow-up Epidemiology of Hearing Loss Study, a population-based longitudinal study of age-related hearing impairment conducted in Beaver Dam, WI. Participants (N = 2,688) were 53-97 years old (mean = 69 years) and 42% were male. Difficulties with communication were assessed by using the Hearing Handicap for the Elderly-Screening version (HHIE-S), with additional questions regarding communication difficulties in specific situations. Health-related quality of life was assessed by using measures of activities of daily living (ADLs), instrumental ADLs (IADLs) and the Short Form 36 Health Survey (SF-36). Hearing loss measured by audiometry was categorized on the basis of the pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz.
Of participants, 28% had a mild hearing loss and 24% had a moderate to severe hearing loss. Severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties. Individuals with moderate to severe hearing loss were more likely than individuals without hearing loss to have impaired ADLs and IADLs. Severity of hearing loss was significantly associated with decreased function in both the Mental Component Summary score and the Physical Component Summary score of the SF-36 as well as with six of the eight individual domain scores.
Severity of hearing loss is associated with reduced quality of life in older adults.
Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes.
To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages.
English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011).
Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels.
One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence.
96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies.
Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found.
Low health literacy is associated with poorer health outcomes and poorer use of health care services.
Agency for Healthcare Research and Quality.
With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.
To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD).
Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, <25 dB [n = 455]; mild loss, 25-40 dB [n = 125]; moderate loss, 41-70 dB [n = 53]; and severe loss, >70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension.
Baltimore Longitudinal Study of Aging.
Six hundred thirty-nine individuals aged 36 to 90 years.
Incident cases of all-cause dementia and AD until May 31, 2008.
During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53).
Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.
http://deepblue.lib.umich.edu/bitstream/2027.42/51484/1/Wallhagen MI, Comparative Impact of Hearing and Vision Impairment, 2001.pdf
To determine whether functional and psychosocial outcomes associated with hearing impairment are a direct result or stem from
prevalent comorbidity, we analyzed the impact of two levels of reported hearing impairment on health and psychosocial functioning
one year later with adjustments for baseline chronic conditions. Physical functioning, mental health, and social functioning
decreased in a dose-response pattern for those with progressive levels of hearing impairment compared with those reporting
no impairment. Our results demonstrate an independent impact of hearing impairment on functional outcomes, reveal increasing
problems with higher levels of impairment, and support the importance of preventing and treating this highly prevalent condition.
In 1994, the U.S. Department of Health and Human Services mandated sufficient inclusion of racial and ethnic minorities in all federally funded research. This mandate requires researchers to monitor study samples for research participation and differential survey nonresponse. This study illustrates methods to assess differential survey nonresponse when population race data are incomplete, which is often the case when studies are conducted among members of health plans.
We collected data as part of the PRISM (Personally Relevant Information about Screening Mammography) study, a trial funded by the National Institutes of Health to increase rates of annual mammography adherence. We used two methods to estimate racial distribution of the PRISM study population. The first method, called E-Tech, estimated race of the sample frame by using individuals' names and zip codes. In the second method, we conducted interviews with a subsample of PRISM study refusals. We validated both estimation methods through comparisons with self-reported race. We used race information generated by E-Tech, interviewer estimates, and self-report to assess differential nonresponse in the PRISM study.
The E-Tech method had moderate sensitivity (48%) in estimating race of black participants but higher specificity (97%) and positive predictive value (71%). The interviewer-estimation method had high sensitivity (100%), high specificity (95%), and moderate positive predictive value (80%). Black women were less likely than white women to be reached for study participation.
There was slight differential nonresponse by race in the PRISM study. Techniques described here may be useful for assessing differential nonresponse in samples with incomplete data on race.
To provide an evidence-based review of plausible causal pathways that could best explain well-established associations between limited health literacy and health outcomes.
Through analysis of current findings in medical and public health literature on health literacy we derived a conceptual causal model.
Health literacy should be viewed as both a patient and a system phenomenon. Three distinct points along a continuum of health care are suggested to be influenced by health literacy: (1) access and utilization of health care, (2) patient-provider relationship, and (3) self-care.
The conceptual model organizes what has been learned to date and underscores promising areas of future inquiry and intervention.
Importance
Hearing impairment (HI) is highly prevalent in older adults and has been associated with adverse health outcomes. However, the overall economic impact of HI is not well described.
Objective
The goal of this review was to summarize available data on all relevant costs associated with HI among adults.
Evidence Review
A literature search of PubMed, Embase, the Cochrane Library, CINAHL, and Scopus was conducted in August 2015. For this systematic review, data extraction and quality assessment were performed by 2 independent reviewers. Eligibility criteria for included studies were presence of quantitative estimation of economic impact or loss of productivity of patients with HI, full-text English-language access, and publication in an academic, peer-reviewed journal or government report prior to August 2015. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A meta-analysis was not performed owing to the studies’ heterogeneity in outcomes measures, methodology, and study country.
Findings
The initial literature search yielded 4595 total references. After 2043 duplicates were removed, 2552 publications underwent title and abstract review, yielding 59 articles for full-text review. After full-text review, 25 articles were included. Of the included articles, 8 incorporated measures of disability; 5 included direct estimates of medical expenditures; 8 included other cost estimates; and 7 were related to noise-induced or work-related HI. Estimates of the economic cost of lost productivity varied widely, from 194 billion in the United States. Excess medical costs resulting from HI ranged from 12.8 billion in the United States.
Conclusions and Relevance
Hearing loss is associated with billions of dollars of excess costs in the United States, but significant variance is seen between studies. A rigorous, comprehensive estimate of the economic impact of hearing loss is needed to help guide policy decisions around the management of hearing loss in adults.
Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Commission on Dementia Prevention, Intervention, and Care met to consolidate the huge strides that have been made and the emerging knowledge as to what we should do to prevent and manage dementia. Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple by 2050. Dementia affects the individuals with the condition, who gradually lose their abilities, as well as their relatives and other supporters, who have to cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour. Additionally, it affects the wider society because people with dementia also require health and social care. The 2015 global cost of dementia was estimated to be US$818 billion, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost.
Hearing loss is remarkably prevalent in the geriatric population: one-quarter of adults aged 60-69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician-patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician-patient communication with older patients that were published since 2000, using the natural language phrase "older patient physician communication." We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician-patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one-quarter of studies of physician-elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.
Hearing loss is a major public health issue independently associated with higher health care costs,¹ accelerated cognitive decline,¹ and poorer physical functioning.¹ More than two-thirds of adults 70 years or older in the United States have clinically meaningful hearing loss.²,3 With an aging society, the number of persons with hearing loss will grow, increasing the demand for audiologic health care services. A recent National Academies of Science, Engineering, and Medicine (NASEM) report¹ highlighted the critical need to address hearing loss and the limitations of current audiologic health care in the United States. In the present study, we used US population projection estimates with current prevalence estimates² of hearing loss to estimate the number of adults expected to have a hearing loss during the next 43 years. These projections can inform policy makers and public health researchers in planning appropriately for the future audiologic hearing health care needs of society.
This study uses data from the Truven Health MarketScan database to compare the costs of health care for a matched cohort of privately insured, middle-aged individuals with and without a diagnosis of hearing loss.Age-related hearing loss affects more than 60% of US adults older than 70 years and has been associated with increased risk of hospitalization,1 decreased quality of life,2,3 and increased risk of functional and cognitive decline.4 The onset of hearing loss is gradual, with prevalence tripling from the age of 50 years to 60 years.3 However, the association between hearing loss in older middle-aged adults (aged 55-64 years) and the use of health care has not been studied. We compared the costs of health care for a matched cohort of privately insured individuals with and without a diagnosis of hearing loss.
To create a more competitive market, PCAST recommends that the US Food and Drug Administration (FDA) classify a certain category of basic hearing aids that could be sold over the counter at drug stores for the treatment of mild to moderate, bilateral, age-related hearing loss (presbycusis)—similar to what is now possible with reading glasses for mild to moderate presbyopia. Currently, the FDA requires a medical examination before a patient can be evaluated by a hearing professional.¹⁰ This requirement stems from the concern that a hearing aid might mask other causes of hearing loss (unusual ones such as acoustic neuroma or more common but easily treatable cerumen impaction), which should be identified and treated separately. Yet the majority of patients who seek hearing help waive the medical requirement, and because only around 20% who have hearing loss actually seek treatment, this approach to identifying treatable ear disorders clearly is not working. PCAST suggests that creating greater access to hearing aids by making the process more patient friendly also would increase awareness about hearing health and could provide a mechanism more effective for identifying these other causes.
Objectives
To determine the association between hearing impairment (HI) and risk and duration of hospitalization in community-dwelling older adults in the United States.DesignProspective observational study.SettingHealth, Aging and Body Composition Study.ParticipantsWell-functioning community-dwelling white and black Medicare beneficiaries aged 70 to 79 at study enrollment in 1997–98 were followed for a median of 12 years.MeasurementsIncidence, annual rate, and duration of hospitalization were the primary outcomes. Hearing was defined as the pure-tone average (PTA) of hearing thresholds in decibels re: hearing level (dB HL) at octave frequencies from 0.5 to 4.0 kHz. Mild HI was defined as a PTA from 25 to 40 dB HL, and moderate or greater HI was defined as a PTA greater than 40 dB HL.ResultsOf the 2,148 participants included in the analysis, 1,801 (83.5%) experienced one or more hospitalizations, with 7,007 adjudicated hospitalization events occurring during the study period. Eight hundred eighty-two (41.1%) participants had normal hearing, 818 (38.1%) had mild HI, and 448 (20.9%) had moderate or greater HI. After adjusting for demographic characteristics and cardiovascular comorbidities, persons with mild HI experienced a 16% (hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.04–1.29) greater risk of incident hospitalization and a 17% (incidence rate ratio (IRR) = 1.17, 95% CI = 1.04–1.32) greater annual rate of hospitalization, and those with moderate or greater HI experienced a 21% (HR = 1.21, 95% CI = 1.06–1.38) greater risk of incident hospitalization and a 19% (IRR = 1.19, 95% CI = 1.04–1.38) greater annual rate of hospitalization than persons with normal hearing. There was no significant association between HI and mean duration of hospitalization.Conclusion
Hearing-impaired older adults experience a greater incidence and annual rate of hospitalization than those with normal hearing. Investigating whether rehabilitative therapies could affect the risk of hospitalization in older adults requires further study.
Hearing impairment (HI) is prevalent, is modifiable, and has been associated with cognitive decline. We tested the hypothesis that audiometric HI measured in 2013 is associated with poorer cognitive function in 253 men and women from Washington County, Maryland (mean age = 76.9 years) in a pilot study carried out within the Atherosclerosis Risk in Communities Neurocognitive Study. Three cognitive tests were administered in 1990-1992, 1996-1998, and 2013, and a full neuropsychological battery was administered in 2013. Multivariable-adjusted differences in standardized cognitive scores (cross-sectional analysis) and trajectories of 20-year change (longitudinal analysis) were modeled using linear regression and generalized estimating equations, respectively. Hearing thresholds for pure tone frequencies of 0.5-4 kHz were averaged to obtain a pure tone average in the better-hearing ear. Hearing was categorized as follows: ≤25 dB, no HI; 26-40 dB, mild HI; and >40 dB, moderate/severe HI. Comparing participants with moderate/severe HI to participants with no HI, 20-year rates of decline in memory and global function differed by -0.47 standard deviations (P = 0.02) and -0.29 standard deviations (P = 0.02), respectively. Estimated declines were greatest in participants who did not wear a hearing aid. These findings add to the limited literature on cognitive impairments associated with HI, and they support future research on whether HI treatment may reduce risk of cognitive decline.
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To the Editor: Hearing loss (HL), a chronic condition that affects nearly two-thirds of older adults in the United States,1 has been independently associated with cognitive decline,2greater number of hospitalizations,3depression,4 and poorer quality of life.5Whether hearing loss is also independently associated with higher medical care expenditures is unclear. We estimated the economic burden of HL in a nationally representative sample of adults aged 65 years or older.
Background Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown.
Methods We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors.
Results In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were −0.65 (95% CI, −0.73 to −0.56) vs −0.46 (95% CI, −0.55 to −0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were −0.83 (95% CI, −0.94 to −0.73) vs −0.63 (95% CI, −0.75 to −0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss.
Conclusions Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.
Objectives:
The purpose of this study was to compare independent impacts of two levels of self-reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning.
Design:
A 1-year prospective cohort study.
Setting:
San Francisco Bay Area, California.
Participants:
Two thousand four hundred forty-two community-dwelling men and women age 50 to 102 from the Alameda County Study (California).
Measurements:
Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self-assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values.
Results:
Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide-ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild.
Conclusions:
These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.
We analyzed data from the 1999-2006 cycles of the National Health and Nutritional Examination Surveys (NHANES), an ongoing epidemiological survey designed to assess the health and functional status of the civilian, noninstitutionalized US population.⁵ Hearing aid use was assessed with an interviewer-administered questionnaire and was based on whether an individual reported wearing a hearing aid at least once a day (1999-2004) or for at least 5 h/wk (2005-2006). Air-conduction pure-tone audiometry was administered to a half sample of all participants aged 50 to 69 years from 1999 through 2004 (n = 1888) and all participants 70 years and older from 2005 through 2006 (n = 717). Audiometry was performed in a sound-attenuating booth according to established NHANES protocols. A speech frequency pure-tone average (average of hearing thresholds at 0.5, 1, 2, and 4 kHz) of greater than 25 dB hearing level (HL) in both ears was defined as hearing loss per World Health Organization criteria,⁶ and this is the level at which hearing loss begins to impair communication in daily life. United States population counts were estimated using the midpoint of population totals in each cycle and averaged across combined cycles when appropriate. We accounted for the complex sampling design in all analyses by using sample weights according to National Center for Health Statistics guidelines.
For individuals 50 years and older in the United States with hearing loss, 1 in 7 individuals uses a hearing aid, and for working-aged adults (50-59 years), the rate of hearing aid use declines to less than 1 in 20. These are the first national estimates of hearing aid prevalence in the US population based on audiometric data and a large, well-characterized representative sample. Previous estimates have ranged between 10% and 20% and have come from industry-supported marketing surveys or cohorts⁷,8 that are not representative of the US population. The low observed rate of hearing aid use in the United States likely has various causes including a general perception of hearing loss being an inconsequential part of the aging process, the absence of health insurance reimbursement for hearing rehabilitative services, and the lack of research on the impact of hearing loss treatment. Only 1 moderately sized randomized controlled trial of hearing aids has ever been conducted to examine the broader impact of hearing aids, and this study showed positive effects of hearing aids on cognition and other functional domains.⁹ Recent research demonstrating strong associations between hearing loss and domains critical to aging (dementia,¹ cognitive functioning,⁴ and falls²,3) highlights the need for further intervention studies to determine the possible role of hearing rehabilitative modalities in helping to mitigate these adverse outcomes. If these studies demonstrate even a small beneficial effect of hearing loss treatment, these findings would have significant implications for public health, given that nearly 23 million older adults have untreated hearing loss.
We analyzed data from the 2001 through 2008 cycles of the National Health and Nutritional Examination Surveys (NHANES), an ongoing epidemiological survey designed to assess the health and functional status of the civilian, noninstitutionalized US population.³ Air conduction pure-tone audiometry was administered to all participants aged 12 to 19 years from 2005 through 2008 (n = 3143), a half sample of all participants aged 20 to 69 years from 2001 through 2004 (n = 3630), and all participants 70 years and older from 2005 through 2006 (n = 717). Audiometry was performed in a sound-attenuating booth according to established NHANES protocols. A speech-frequency pure-tone average (average of hearing thresholds at 0.5, 1, 2, and 4 kHz) of greater than 25 dB HL (hearing level) in both ears was defined as hearing loss per WHO criteria,⁴ and this is the level at which hearing loss begins to impair communication in daily life. Hearing loss prevalence was estimated by age decade, sex, and the 3 largest categories of race/ethnicity (non-Hispanic white [white], non-Hispanic black [black], and Mexican American or other Hispanic [Hispanic]). There were insufficient individuals from other racial/ethnic groups to derive reliable age-stratified estimates. However, individuals from all racial and ethnic categories were included in estimates of overall prevalence. US population counts were estimated using the midpoint of population totals in each cycle and averaged across combined cycles when appropriate. We accounted for the complex sampling design in all analyses by using sample weights according to National Center for Health Statistics (NCHS) guidelines.
OBJECTIVE: To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). METHODS: Review of the literature. RESULTS: Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. CONCLUSION: Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care.
To develop and validate a general method (called regression risk analysis) to estimate adjusted risk measures from logistic and other nonlinear multiple regression models. We show how to estimate standard errors for these estimates. These measures could supplant various approximations (e.g., adjusted odds ratio [AOR]) that may diverge, especially when outcomes are common.
Regression risk analysis estimates were compared with internal standards as well as with Mantel-Haenszel estimates, Poisson and log-binomial regressions, and a widely used (but flawed) equation to calculate adjusted risk ratios (ARR) from AOR.
Data sets produced using Monte Carlo simulations.
Regression risk analysis accurately estimates ARR and differences directly from multiple regression models, even when confounders are continuous, distributions are skewed, outcomes are common, and effect size is large. It is statistically sound and intuitive, and has properties favoring it over other methods in many cases.
Regression risk analysis should be the new standard for presenting findings from multiple regression analysis of dichotomous outcomes for cross-sectional, cohort, and population-based case-control studies, particularly when outcomes are common or effect size is large.
Relative excess risk due to interaction, the proportion of disease among those with both exposures that is attributable to their interaction, and the synergy index have been proposed as measures of interaction in epidemiologic studies. This paper presents the methodology for obtaining confidence interval estimates of these indices utilizing routinely available output from multiple logistic regression software.
Severe to profound hearing impairment affects one-half to three-quarters of a million Americans. To function in a hearing society, hearing-impaired persons require specialized educational, social services, and other resources. The primary purpose of this study is to provide a comprehensive, national, and recent estimate of the economic burden of hearing impairment.
We constructed a cohort-survival model to estimate the lifetime costs of hearing impairment. Data for the model were derived principally from the analyses of secondary data sources, including the National Health Interview Survey Hearing Loss and Disability Supplements (1990-91 and 1994-95), the Department of Education's National Longitudinal Transition Study (1987), and Gallaudet University's Annual Survey of Deaf and Hard of Hearing Youth (1997-98). These analyses were supplemented by a review of the literature and consultation with a four-member expert panel. Monte Carlo analysis was used for sensitivity testing.
Severe to profound hearing loss is expected to cost society 1 million.
Results indicate that an additional $4.6 billion will be spent over the lifetime of persons who acquired their impairment in 1998. The particularly high costs associated with prelingual onset of severe to profound hearing impairment suggest interventions aimed at children, such as early identification and/or aggressive medical intervention, may have a substantial payback.
In the analysis of covariance, the display of adjusted treatment means allows one to compare mean (treatment) group outcomes controlling for different covariate distributions in the groups. Predictive margins are a generalization of adjusted treatment means to nonlinear models. The predictive margin for group r represents the average predicted response if everyone in the sample had been in group r. This paper discusses the use of predictive margins with complex survey data, where an important consideration is the choice of covariate distribution used to standardize the predictive margin. It is suggested that the textbook formula for the standard error of an adjusted treatment mean from the analysis of covariance may be inappropriate for applications involving survey data. Applications are given using data from the 1992 National Health Interview Survey (NHIS) and the Epidemiologic Followup Study to the first National Health and Nutrition Examination Survey (NHANES I).
Health economists often use log models to deal with skewed outcomes, such as health utilization or health expenditures. The literature provides a number of alternative estimation approaches for log models, including ordinary least-squares on ln(y) and generalized linear models. This study examines how well the alternative estimators behave econometrically in terms of bias and precision when the data are skewed or have other common data problems (heteroscedasticity, heavy tails, etc.). No single alternative is best under all conditions examined. The paper provides a straightforward algorithm for choosing among the alternative estimators. Even if the estimators considered are consistent, there can be major losses in precision from selecting a less appropriate estimator.
Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.
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Association between hearing loss and healthcare expenditures in older adults.
- Foley
Studies of physician-patient communication with older patients: how often is hearing loss considered? a systematic literature review.
- Cohen