Age-based disparities in hearing loss diagnosis and treatment in the United States population.

OBJECTIVE: To investigate age-related disparities in the diagnosis and treatment of borderline/mild hearing loss (HL) in the United States. STUDY DESIGN: A cross-sectional epidemiologic study. SETTING: The National Health and Nutrition Examination Survey (NHANES). METHODS: Multivariable logistic regressions controlling for hearing level were performed to investigate the association between: (1) age and recent hearing test; (2) age and hearing aid use. Age was grouped into quartiles (<25, 25-49, 50-74, ≥75 years). The first quartile of life was used as a reference group in all odds ratios, controlling for hearing level. RESULTS: Of 2115 participants with borderline/mild HL, 3 % (n = 53) were in age quartile Q1; 7 % (n = 147) were in Q2, 56 % (n = 1190) were in Q3, and 34 % (n = 725) were in Q4. Compared to Q1, those in Q2, Q3, and Q4 had 4.06 times (95 % CI = 2.11-8.02, p < 0.001), 4.51 times (2.56-8.19, p < 0.001), and 4.56 times (2.55-8.39, p < 0.001) lower odds of a hearing test within the past 4 years. Similar, although slightly larger, odds ratios were obtained when the outcome was hearing test within 1 year. Compared to Q1, those in Q2, Q3, and Q4 respectively had 4.38 times (1.47-13.5, p < 0.05), 5.41 times (2.27-11.8, p < 0.001), and 3.95 times (1.65-8.72, p < 0.05) lower odds of using a hearing aid. CONCLUSION: We have characterized a large, unaddressed, and modifiable disparity in the treatment of borderline/mild HL as individuals age out of the first quartile of life. Future studies are needed to explore factors, such as ageism, that may underlie these findings.

National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss.

OBJECTIVE: To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among US Hispanic adults. STUDY DESIGN AND SETTING: Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered US volunteers. METHODS: Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry. RESULTS: A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics. CONCLUSION: SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.