June 13, 2024

Hearing loss is a prevalent issue that has a negative influence on interpersonal communication and is associated with certain health outcomes such as poor quality of life, depression, dementia, and death. However, the efficacy of rehabilitation using hearing aids in lowering mortality remains unclear.

Study: Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort. Image Credit: Peakstock / Shutterstock.com

About the study

In a recent study published in The Lancet Healthy Longevity, researchers determine the relationship between the use of hearing aids and mortality among adult United States residents with hearing impairment participating in the 1999-2012 National Health and Nutrition Examination Survey (NHANES).

A total of 9,885 NHANES respondents who completed hearing aid usage and audiometry questionnaires were included in the analysis. Using hearing aids regularly was the primary exposure, with individuals who infrequently used hearing aids excluded to explore the impact of consistent hearing aid usage on mortality. The study included variables and participants with comprehensive data on audiometry-determined hearing, hearing aid usage, and death.

The primary measures were hearing impairment and the use of hearing aids, with study participants classified as frequent users, never users, and non-regular users. Hearing aid usage was assessed once during study participation, in which users were classified as regular or non-regular users according to the stated use frequency.

According to the World Health Organization (WHO) grading, hearing impairment was classified as mild, moderate, severe, or profound. Study participants were considered frequent users of hearing aids if they reported wearing a hearing aid once or more each week, once or more a day, or almost always, for five hours or more every week, or 50% of the time or more, usually or always.

Probabilistic matching of NHANES data and mortality records through December 31, 2019 from the National Mortality Index were used to estimate mortality status, which allowed NHANES survey data to be correlated with death information from the Index.

In August 2023, the study data were analyzed using Cox proportional hazards regression modeling to determine the relationship between hearing impairment and all-cause mortality. Hazard ratios (HRs) were adjusted for age, hearing loss, demographics, medical history, sex, race, education, poverty-to-income ratios, marital status, insurance, smoking, body mass index (BMI), diabetes, hypertension, cardiovascular disease, and stroke.

Study findings

The study included 9,885 individuals, 1,863 of whom had audiometry-determined hearing loss during their NHANES participation. During a median of ten years of follow-up, the hearing impairment prevalence and any-cause death rates were 15% and 13%, respectively.

Regular use of hearing aids was 13% among individuals with hearing impairments, whereas non-regular-type hearing aid usage was 66%. Hearing impairment independently increased mortality risk, with frequent users of hearing aids having a lower adjusted death risk than non-users.

No significant difference was observed in adjusted death rates between non-regular and non-users of hearing aids. The estimated prevalence of audiometry-measured hearing impairment in individuals aged 20 and older in the United States was 15%.

Poor hearing was related to an increased risk of death, with those with hearing impairment having a significantly higher age-adjusted mortality risk with an HR of 1.7. Considering medical history and demographics, the adjusted odds of death remained considerably higher among individuals with hearing impairment with an HR of 1.4. The mortality risk was lower in individuals who reported frequent hearing aid usage than those who never used hearing aids, controlling for participant age and the extent of hearing impairment.

In a multivariate model that controlled for age, demographics, and the severity of hearing impairment, individuals who reported frequent hearing aid usage had a significantly reduced risk of death than those who did not.

In the first sensitivity evaluation, ever users of hearing aids, which included non-regular and regular users, were compared to non-users. To this end, ever users had a reduced risk of death than non-users when age, hearing impairment, and demographics were considered. The subsequent evaluation, which limited the analysis to NHANES 2005-2012 individuals, found that frequent hearing aid usage was related to a reduced mortality risk.

Conclusions

The study findings indicate that frequent hearing aid usage by adult U.S. residents with hearing impairment was related to decreased mortality risks despite age, hearing impairment, and demography. Regular users had a higher socioeconomic class and fewer medical comorbidities, thus implying improved health awareness and attendance at medical checkups. These individuals also have better access to healthcare, which is associated with a lower death rate.

Multiple pathways, including shared diseases affecting both hearing and comorbidities leading to death, have been postulated to explain the link between hearing impairment and mortality. Nevertheless, future studies are needed to determine the impact of hearing aid usage on health outcomes and death.

Journal reference:

  • Choi, J. S., Adams, M. E., Crimmins, E. M., et al. (2024). Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort. The Lancet Healthy Longevity 5; e66–75, doi:10.1016/S2666-7568(23)00232-5

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