Association Between Adult-Onset Hearing Loss and Income: A Systematic Review.

INTRODUCTION: Hearing loss has been shown to be associated with both negative health outcomes and low socioeconomic position, including lower income. Despite this, a thorough review of the existing literature on this relationship has not yet been performed. OBJECTIVES: To evaluate available literature on the possible association between income and adult-onset hearing loss. DESIGN: A search was conducted in eight databases for all relevant literature using terms focused on hearing loss and income. Studies reporting the presence or absence of an association between income and hearing loss, full-text English-language access, and a predominantly adult population (≥18 years old) were eligible. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. RESULTS: The initial literature search yielded 2994 references with three additional sources added through citation searching. After duplicate removal, 2355 articles underwent title and abstract screening. This yielded 161 articles eligible for full-text review resulting in 46 articles that were included in qualitative synthesis. Of the included studies, 41 of 46 articles found an association between income and adult-onset hearing loss. Due to heterogeneity among study designs, a meta-analysis was not performed. CONCLUSIONS: The available literature consistently supports an association between income and adult-onset hearing loss but is limited entirely to cross-sectional studies with the directionality remaining unknown. An aging population and the negative health outcomes associated with hearing loss, emphasize the importance of understanding and addressing the role of social determinants of health in the prevention and management of hearing loss.

The Geographic Distribution of Videolaryngostroboscopy in the United States.

PURPOSE: To study the geographic utilization of videolaryngostroboscopy (VLS) with the hypothesis that office-based voice care is unevenly distributed across the United States. MATERIALS AND METHODS: This is a cross-sectional database analysis of Medicare beneficiaries. The Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Physician and Other Supplier Public Use File from 2012 to 2017 was analyzed to evaluate VLS utilization. VLS distribution was assessed by calculating the density of VLS in each of the 306 hospital referral regions (HRRs) nationally. Associations between VLS density and population demographics and health system factors were assessed using Pearson correlation and multivariate regression analyses. RESULTS: In total, 957,648 outpatient VLS were billed to Medicare part B between 2012 and 2017. The annual VLS density per HRR ranged from 0 to 38.2 per 1,000 enrollees. Pearson correlation revealed positive correlations between VLS density and number of Medicare enrollees (r = 0.2584, P < 0.001), income (r = 0.1913, P = 0.0008), education (r = 0.2089, P = 0.0002), and density of otolaryngologists (r = 0.1589, P = 0.0053) and medical specialists (r = 0.2326, P < 0.0001). A negative Pearson correlation was observed between VLS density and percent male (r = -0.1338, P = 0.0192) and Medicare mortality rate (r = -0.1628, P = 0.0043). On multivariate regression positive associations between VLS and number of Medicare enrollees (P = 0.002) and otolaryngologists (P = 0.049), and negative association with Medicare mortality rates (P = 0.032) remained significant. CONCLUSIONS: The distribution of office-based voice care varies widely across the country, even when analysis by HRR should have homogenized access to specialty care. Greater availability of VLS is seen in HRRs with more Medicare enrollees, greater density of otolaryngologists, and lower mortality rates.

Encounters and management of oral conditions at general medical practices in Australia.

BACKGROUND: Poor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions. METHODS: Data from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics. RESULTS: A total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications. CONCLUSIONS: This study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

A Broad Examination of Health Policy Barriers to Access and Affordability of Hearing Treatment for Medicare Beneficiaries.

In 2016, the National Academies on Science, Engineering, and Medicine (NASEM) released a report titled, "Hearing Health Care for Adults," which detailed the challenges and provided recommendations for improving the access to affordable hearing care for adults in the United States. Arguably the most significant outcome from this report was the subsequent passage of the Over-the-Counter Hearing Aid Act in 2017, which requires the Food and Drug Administration to develop regulations for a class of hearing aids that address mild to moderate hearing loss to be available for sale over the counter (OTC). While this presents an important step toward improving access and affordability of hearing treatment, it does not represent a complete solution. In fact, optimizing the new landscape of hearing care for individuals with hearing loss also may require new policy solutions. This article reflects on the progress achieved since the NASEM report and the policy issues that remain to improve accessibility and affordability of hearing care among older adults.

Racial and Ethnic Differences in Hearing Aid Use Among Medicare Beneficiaries.

OBJECTIVES: We examined individual-level factors associated with hearing aid use by race and ethnicity in a nationally representative sample of Medicare beneficiaries. METHODS: We used the Medicare Current Beneficiary Survey (cycles 2016-2018) for 10,301 older adults with hearing loss and hearing aid use as the primary outcome. Covariates included education, income, urban residence, chronic conditions, functional limitations, and Medicaid eligibility. Multivariable logistic regression stratified by race and ethnicity was used to identify factors associated with hearing aid use. RESULTS: Factors associated with hearing aid use included higher education among White (OR = 1.35, 95%CI:1.16, 1.58), Black (OR = 1.76, 95%CI:1.02, 3.05), and Hispanic (OR = 1.77, 95%CI:1.17, 2.68) beneficiaries. Urban residence was associated with hearing aid use for Black participants (OR = 3.06, 95%CI:1.17, 8.03) and Medicaid eligibility for Hispanic participants (OR = 1.58, 95%CI:0.97, 2.59), although the confidence interval included the null hypothesis. DISCUSSION: ndividual-level factors associated with hearing aid use differed by race and ethnicity among Medicare beneficiaries.

Sensory Impairment and the Odds of Adverse Consequences of Unmet Needs for Care Among Older Adults.

OBJECTIVES: Vision and hearing impairments are highly prevalent conditions among older adults, and well-established links exist between sensory impairment and household, mobility, and self-care activity limitations. However, studies examining the impact of unmet long-term services and supports (LTSS) needs have not considered the role of vision and hearing impairment on the risk of experiencing adverse consequences, including wetting or soiling oneself. METHOD: Using Rounds 1 and 5 of the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries aged 65 and older, we examine the association of vision and hearing impairment on the odds of experiencing an adverse consequence while accounting for other sociodemographic and health status factors. RESULTS: Among a weighted population of 49,770,947 community-living older adults with limitations in household, mobility, or self-care activities, 20.1% (95% CI: 19.2-21.0) experienced an adverse consequence as a result of unmet LTSS needs. In the fully adjusted regression, individuals with vision or hearing impairment had 96% (odds ratio [OR]: 1.96; 95% CI: 1.64-2.34) and 43% increased odds (OR: 1.43; 95% CI: 1.24-1.65), respectively, of experiencing any adverse consequence. Hearing impairment was associated with higher odds of household or self-care adverse consequences, while vision impairment was associated with higher odds of mobility or self-care adverse consequences. DISCUSSION: Sensory impairment may increase the risk for adverse consequences for older adults with unmet LTSS needs. Activities that support older adults living safely in the community should consider the role of sensory impairment and how to address the unique needs of those with hearing or vision impairment.

Association of Sensory Loss With the Knowledge of Heart Attacks.

INTRODUCTION: Awareness of heart attack symptoms and the best response is a national public health priority, especially among those at higher risk of heart disease. Adults with sensory loss are more likely to develop heart disease than those without and may be at risk of poor heart attack knowledge owing to limited patient-provider communication and access to health information. The aim of this study is to examine the association between sensory loss and heart attack knowledge. METHODS: Cross-sectional, nationally representative data from the 2014 and 2017 National Health Interview Survey were used. Analyses were conducted in 2021. Participants aged ≥20 years were included (N=61,168). Being aware of heart attack symptoms and the best response was considered as recognizing the 5 examined symptoms of heart attacks and the proper emergency response, as defined in the Healthy People 2020 objectives. Functional hearing and vision losses were defined as self-reported difficulty in hearing and seeing. RESULTS: Overall, 16.2% reported functional hearing loss, and 10.1% reported vision loss. Having vision loss was associated with a lack of knowledge of heart attacks symptoms or the best response (prevalence ratio=1.08, 95% CI=1.06, 1.11). In a separate model, having vision loss only and dual sensory loss (concurrent vision and hearing loss) were associated with not having this knowledge (prevalence ratio=1.09, 95% CI=1.06, 1.12 and PR=1.08, 95% CI=1.01, 1.15, respectively), but having hearing loss only was not (prevalence ratio=1.03, 95% CI=0.99, 1.06). CONCLUSIONS: Non-institutionalized adults with sensory loss may represent a group to target for improving the knowledge of heart attacks in the population.

Alternative Pathways for Hearing Care May Address Disparities in Access.

Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment. Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey. Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities. Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use. Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized. Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income. Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.

Changes in US hearing aid regulations: possible benefits and risks to Australia.

OBJECTIVE: Hearing aids are costly for many Australians with hearing loss who are not eligible for public funding, and are not widely used. The purpose of this article is to describe a recent policy shift from the United States (US) that might improve access to hearing devices and services in Australia. Type of program or service: In 2017, the US legislated the Over-the-Counter Hearing Aid Act of 2017, directing the Food and Drug Administration (FDA) to develop regulations for over-the-counter sale of hearing aids for mild to moderate hearing loss. FINDINGS: Changes in the development of hearing devices and changes to service delivery were well underway in the US prior to anticipated release of new FDA regulations, with new technology entrants in the 'hearables' market. For Australians with hearing loss not eligible for public funding, the current hearing health system is expensive and device-centred. If Australia follows suit with regulatory changes for a class of over-the-counter hearing aids, consumers are likely to benefit from access to safe and affordable devices. Additional policies to support access to hearing services are also likely to be needed. LESSONS LEARNT: The hearing health system in Australia will undergo tremendous change in the coming years because of the introduction of over-the-counter hearing aids in the US. For Australians to benefit, changes to regulations of devices, as well as hearing services and device provision, will be required.

Factors Associated With Hearing Aid Use Among Medicare Beneficiaries.

BACKGROUND AND OBJECTIVES: In the United States, up to two-thirds of older adults have hearing loss. Untreated hearing loss can have significant health outcomes, yet less than 20% of adults with hearing loss use hearing aids. In this study, we examined potential factors associated with hearing aid use, including detailed measures of health status, access to care, patient engagement, and technology use, in a nationally representative sample of Medicare beneficiaries. RESEARCH DESIGN AND METHODS: Cross-sectional study using the 2017 Medicare Current Beneficiary Survey. Participants with self-reported hearing loss were included. The primary outcome was hearing aid use. Factors potentially associated with hearing aid use included: sociodemographics, health determinants, access to care, patient activation, and technology access/use. RESULTS: Overall, 5,146 participants were included. Of them, 27% reported using hearing aids. In a multivariable logistic regression model, predisposing factors associated with greater odds of hearing aid use included older age, identifying as a man, identifying as White, having completed college, having 3 or more chronic conditions, having dementia, not having trouble seeing, not having limitations in activities of daily living, having moderate relative to low information-seeking scores, and having a personal computer at home (range of odds ratios [ORs]: 1.22-4.46). Enabling factors associated with greater odds of hearing aid use included higher income, living alone relative to living with family members other than a spouse, and having a usual source of care (range of ORs: 1.43-1.54). DISCUSSION AND IMPLICATIONS: In addition to addressing previously identified factors associated with hearing aid use, improving access to health care, technology, and information about hearing aids may improve the uptake of hearing aids. These findings help further inform our understanding on how to address low treatment levels of hearing loss in the community by identifying new populations to target and potentially modifiable risk factors for hearing aid use.

Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs.

Hearing loss is associated with higher health care spending and use, but little is known about the unmet health care needs of people with hearing loss or difficulty. Analysis of 2016 Medicare Current Beneficiary Survey data for beneficiaries ages sixty-five and older reveals that those who reported a lot of trouble hearing in the past year were 49 percent more likely than those who reported no trouble hearing to indicate not having a usual source of care. Compared with those who reported no trouble hearing, those who reported some trouble hearing were more likely to indicate not having obtained medical care in the past year when they thought it was needed, as well as not filling a prescription, with the risk for both behaviors being greater among those reporting a lot of trouble hearing versus a little. Interventions that improve access to hearing services and aid communication may help older Medicare beneficiaries meet their health care needs.

Association of Self-Reported Trouble Hearing and Patient-Provider Communication with Hospitalizations among Medicare Beneficiaries.

Several studies have recently illuminated the relationship between hearing loss and hospitalizations, but little is understood as to why hearing loss is associated with greater risk for hospitalizations. This study examines the role of patient-provider communication as the mechanism by which those with hearing loss are more likely to be hospitalized, using the self-reported data from 12,654 Medicare beneficiaries from the 2016 Medicare Current Beneficiary Survey (MCBS) Cost and Use File. Multivariable logistic regression was used to model the odds of any hospitalization in the past year and negative binomial regression to model the incident rate ratio of hospitalization based on number of hospitalizations in the past year. It was found that Medicare beneficiaries who experience impaired communication with their physician due to trouble hearing have greater odds of hospitalization and a higher rate of all hospitalization over a 1-year period. Understanding the complex relationship between hearing loss, patient-provider communication, and hospitalizations may provide health care professionals with a better rational to address not only hearing loss but also impaired communication in the care of an individual.

Preventive Care Utilization among Adults with Hearing Loss in the United States.

Hearing loss (HL) can negatively impact patient-provider communication and limit access to health promotion information, which may lead to decreased preventive care utilization. Using data from the 2015 and 2018 National Health Interview Survey, we examined the association between perceived HL with and without hearing aid use with self-reported age-appropriate uptake of breast and colon cancer screening, and influenza and pneumococcal vaccination. In models adjusted for sociodemographic characteristics, access to care, and health status, people with HL had lower odds of receiving breast cancer screening (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.72-0.96) and higher odds of receiving pneumococcal vaccination (OR = 1.11, 95% CI = 1.00-1.24) relative to those without HL. There were no differences in their colon cancer or influenza vaccination uptake. Compared with those without HL, people with HL who used hearing aids had increased odds of colon cancer screening and influenza and pneumococcal vaccination, while people with HL who did not use hearing aids were less likely to report cancer screening. Overall, Americans with untreated HL were less likely to report completing cancer screening. Hearing aid use may modify the association between HL and preventive care uptake. Screening for HL in primary care settings and communication trainings for providers may help reduce cancer screening disparities.

Healthcare-Seeking Behaviors Among Medicare Beneficiaries by Functional Hearing Status.

Objective: Hearing loss is associated with higher health expenditures and poor healthcare utilization. This study aims to build on these findings by characterizing the association between hearing status and healthcare-seeking behaviors among Medicare beneficiaries. Methods: Cross-sectional log-binominal regression was used to assess the association between self-report hearing and healthcare-seeking behaviors (avoidance or delay of care, personal health concerns, and sharing health status) using the 2016 Medicare Current Beneficiary Survey (N = 12,140). Results: Beneficiaries with trouble hearing had significantly higher risks of avoiding and delaying health care compared to those without trouble hearing. Conversely, trouble hearing was not associated with concern for health status or sharing health status. Discussion: These findings may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying causes and whether addressing hearing loss modifies the observed association.

Hearing Loss and Home Health: An Unmet Need and an Opportunity for Action.

The purpose of this study was to identify unmet hearing care needs among older adults receiving home healthcare as a potential method to reach a population unserved by clinic-based care. Cross-sectional analyses were used to identify hearing loss and hearing aid use among beneficiaries enrolled in home care, using data from the nationally representative 2017 Medicare Current Beneficiary Survey (MCBS). Survey participants who reported enrollment in home healthcare services in 2017 (n = 3,183,693) were included for the purposes of analyses. Home health and hearing status were assessed through MCBS questionnaires, reported by Medicare beneficiaries or an appointed proxy, along with hearing status evaluated at initial home care intake. Among older Medicare beneficiaries receiving home healthcare, 51.8% self-reported hearing concerns. Of this population, only 16.1% reported hearing aid use. Recipients with hearing difficulty received an average of 30 visits per year, totaling to $5,208.25 in expenditure. By self-report, 44% of older home care recipients with hearing difficulty were misclassified as having "adequate" hearing on initial assessment and 31% of initial assessments identified hearing loss among those who self-reported no difficulty hearing. Effective management of chronic health conditions is core to healthy aging, including sensory health. Hearing loss represents a largely unaddressed need among home care recipients and frequently goes unidentified. Home-based hearing services that integrate into existing assessments and practices may be an avenue in identifying hearing loss and extending care to older adults who have traditionally gone without access to hearing intervention.

Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss.

BACKGROUND/OBJECTIVES: Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing loss and dissatisfaction with quality of health care over the past year among Medicare beneficiaries. METHODS: Cross-sectional study of satisfaction with quality of health care among Medicare beneficiaries with self-reported trouble hearing from the 2015 Medicare Current Beneficiaries Survey. There were 11,441 Medicare beneficiaries representing a 48.6 million total weighted nationally representative sample. RESULTS: Forty-eight percent of Medicare beneficiaries reported a little or a lot of trouble hearing. Medicare beneficiaries with a little trouble hearing (odds ratio=1.496; 95% confidence interval, 1.079-2.073; P=0.016) and a lot of trouble hearing (odds ratio=1.769; 95% confidence interval, 1.175-2.664; P=0.007) had 49.6% and 76.9% higher odds of being dissatisfied with the quality of their health care over the previous year, respectively. CONCLUSIONS: Medicare beneficiaries with functional hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Given Medicare's reliance on patient satisfaction as a value-based measure for hospital reimbursement, interventions to address hearing loss in the health care system are needed.