Hearing Health Care for Adults Priorities for Improving Access and Affordability (2016) / Chapter Skim
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2 Hearing Loss: Extent, Impact, and Research Needs
2 Hearing Loss: Extent, Impact, and Research Needs
Pages 35-74
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From page 35... ...
. Lessening the effects of hearing loss and improving health and function are the goals of this report's discussions.
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Because childhood onset of hearing loss as well as most types of acquired hearing loss in adolescence and the early adult years are relatively rare, and because the most common type of hearing loss among aging adults is a slowly developing, symmetrical sensorineural hearing loss called age-related hearing loss or presbycusis, population-based cohorts primarily focus on age-related hearing loss. Box 2-1 OVERVIEW OF SELECTED STUDIES Baltimore Longitudinal Study of Aging (1958 to ongoing)
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From page 37... ...
Hispanic Community Health Study/Study of Latinos (2008 to 2011) -- This population-based study examined the prevalence and potential risk factors associated with hearing impairment among self-identified Hispanic/Latino adults of ages 18 to 74 years from randomly selected households in four U.S.
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From page 38... ...
The Blue Mountains cohort in Australia was designed to be comparable to the Beaver Dam cohort, and the incidence rates appear remarkably similar when comparing rates using the same pure tone average definition (42.2 per 1,000 individuals per year in the Blue Mountain Hearing Study and 42.8 per 1,000 individuals per year in the Epidemiology of Hearing Loss Study) (Cruickshanks et al., 2003; Mitchell et al., 2011)
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From page 39... ...
. Age and Sex Figure 2-1 shows the age- and sex-specific 5-year incidence of hearing loss in either ear from the Epidemiology of Hearing Loss Study and for bilateral hearing loss in the Blue Mountains Hearing Study (Cruickshanks et al., 2003; Mitchell et al., 2011)
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Epidemiology of Hearing Loss PTA of 0.5, 1, 2, and 4 kHz > 25 dB HL in 5, 10, or 15 years 5 years: 21.4 5 years: 42.8 Study either ear 10 years: 37.2 10 years: 37.2 N = 1,678c Age of participants: 48–92 years 15 years: 56.8 15 years: 37.9 (Cruickshanks et al., 2003, 2010a, 2015b) Blue Mountains Hearing Study PTA of 0.5, 1, 2, and 4 kHz > 25 dB HL in 5 years 17.9 35.8 N = 870 better ear (Mitchell et al., 2011)
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; N = number of participants without hearing loss at baseline; NA = not available; PTA = pure tone average. aNumber of individuals followed for progression of hearing decline.
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At the 5-year follow-up examinations, EHLS participants R03006 were 53–97 years of age and BMHS participants were 54 years and older. NOTE: BMHS = Blue Mountains Hearing Study; EHLS = Epidemiology of Hearing Loss Study.
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20 dB HL in worse ear PTA of 0.5, 1, and 2 kHz ≥ 31 25 dB HL in better ear PTA 0.5,1,2,3 > 25 dB HL in better 36 ear PTA 0.5,1,2,4 > 25 dB HL in better 47 ear Framingham Heart Study PTA of 0.5 to 4 kHz > 26 dB HL in 29 N = 1,662; 40.7% men better ear Age of participants: 63–95 years (Gates et al., 1990) Hispanic Health and Nutrition PTA of 0.5, 1, and 2 kHz > Age-, sex-, Examination Survey 25 dB HL in either ear and ethnic N = 2,751; % men not reported background Age of participants: 20–74 years specific rates (Lee et al., 1991)
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Beaver Dam Offspring Study PTA of 0.5, 1, 2, and 4 kHz > 14.1 N = 2,837; 45.6% men 25 dB HL in worse ear Age of participants: 21–84 years (Nash et al., 2011) Hispanic Community Health Study/ PTA of 0.5, 1, 2, and 4 kHz > Better ear: 8.24 Study of Latinos 25 dB HL in better ear; worse ear Worse ear: 15.06 2008–2011 N = 16,415; 47.97% men Age of participants: 18–74 years (Cruickshanks et al., 2015a)
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From page 45... ...
The severity of the loss may affect hearing health care needs in various important ways. For example, older adults with profound hearing loss may be candidates for cochlear implants, but this surgical intervention would not be appropriate for someone with a mild loss.
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. In 1982–1984 the Hispanic Health and Nutrition Examination Survey was launched to measure the health of a representative sample of Mexican Americans from the southwestern United States, Cuban Americans from the Miami, Florida, area, and Puerto Ricans from New York City (Lee et al., 1991)
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. A strong birth cohort effect was found using data from the Epidemiology of Hearing Loss Study cohort and their offspring (Beaver Dam Offspring Study)
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Additionally, the surge of older Americans caused by the aging of the boomer cohort raises concerns about the aggregate demands for hearing health care. The slow gradual changes also can mean that adults may not 100 90 Prevalence of Hearing Loss (%)
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HEARING LOSS: CAUSES AND RISK FACTORS The complexity of the physiologic and neural mechanisms that undergird hearing and communication in combination with the numerous genetic and environmental factors that can be associated with or the cause of hearing loss makes it a challenging area for research and one in which much remains to be learned. The major causes and risk factors for hearing loss fall into two major categories, congenital and acquired, although there are complex overlaps between the two, including the potential contributions of genetic susceptibilities to certain risk factors.
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, and few have controlled analyses for factors other than noise or age. One recent report from the Millennium Cohort Study of veterans demonstrated that deployment to combat zones, proximity to improvised explosive devices, and combat-related head injuries were associated with new-onset hearing loss (Wells et al., 2015)
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. Risk Factors for Age-Related Hearing Loss The most common form of acquired hearing loss and the focus of the previously reviewed epidemiological studies is age-related hearing loss.
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. One study found that current smokers had a 31 percent increased risk of developing hearing loss during 15 years of follow-up (Cruickshanks et al., 2015b)
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. In the Epidemiology of Hearing Loss Study, there was an 8 percent increased risk of hearing loss for every additional 10 centimeters of waist circumference (Cruickshanks et al., 2015b)
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. Non-HDL cholesterol was not associated with the incidence of hearing loss in either the Epidemiology of Hearing Loss Study or the Beaver Dam Offspring Study (Cruickshanks et al., 2015b; Fischer et al., 2015)
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In short, there is tremendous heterogeneity in the challenges in everyday life that are attributed to hearing loss because of the complex interactions of individuals and their environments. This highlights the need for a personalized approach to hearing health care.
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A longitudinal analysis of data from the Blue Mountains Hearing Study found no difference in the rate of decline in quality of life over a 10-year period between participants with hearing loss and those with normal hearing at baseline, nor was baseline hearing ability associated with the rate of decline in quality of life (Gopinath et al., 2012)
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In one longitudinal study of people with audiometrically measured hearing loss, there was no difference between hearing aid users and nonusers in cognitive function or mental health after 11 years of follow-up (Dawes et al., 2015)
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In one study that controlled for hearing impairment severity, older adults reported less handicap than younger adults, which may reflect differences in demands on hearing, generational differences in coping, or adaptation to hearing loss over time (Wiley et al., 2000)
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In the Blue Mountains Hearing Study, 1,457 participants at the baseline hearing test visit reported no use of community support services. Baseline hearing loss was not associated with the 5-year incidence of using community support services, with receiving help from a nonspouse family member or friend, or with an inability to go out alone.
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. Because hearing aids are frequently used by children with hearing loss, long-term hearing health care is needed to help them continue to thrive as adults.
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(10.67) Health insurance 55.5 47.7 40.4 29.2 (0.79)
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However, there are very limited data about their hearing health care needs or how its affordability may limit their access and opportunities. Economic Burden of Hearing Loss There are no population-based longitudinal data that measure the economic impact of hearing loss.
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Simpson and colleagues (2016) examined health care cost data from privately insured adults age 55 to 64 years and found higher health care costs for a number of chronic health conditions for individuals with a diagnostic code for hearing loss as compared with a matched group without that diagnostic code.
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Given the number of people with hearing loss and the opportunities to improve their function and quality of life, more can be done to strengthen the evidence base. Of the numerous factors that have contributed to hearing health care's lack of a strong research base, the committee describes just a few: • Lack of health insurance coverage for hearing health care -- Evidence of improved patient outcomes is a general requisite for
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From page 65... ...
Additionally, health services researchers, health economists, and epidemiologists receive little training about sensory disorders. Strengthening the research training programs and encouraging multidisciplinary teams to address the many re search needs will improve the quality of the evidence in hearing health care.
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Goal 1: Improve Population-Based Information on Hearing Loss and Hearing Health Care Recommendation 1: The National Institutes of Health, the Centers for Disease Control and Prevention, the Patient-Centered Outcomes Research Institute, the Department of Defense, the Department of Veterans Affairs, state public health agencies, and other relevant gov ernment agencies, as well as nonprofit organizations, hearing health care professional associations, academic institutions, and researchers, should strengthen efforts to collect, analyze, and disseminate prospec tive population-based data on hearing loss in adults and the effects of hearing loss and its treatment on patient outcomes. Specifically, • Support and conduct studies to develop, evaluate, strengthen, and align metrics for hearing loss and communication abilities; • Support and conduct studies, including longitudinal studies, in diverse populations to better understand o risk and natural history of hearing loss, the o risk factors and comorbidities of hearing loss, o hearing health care needs, and
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2010. Impact of hearing impairment on spousal men tal health: The Nord-Trøndelag Health Study.
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2008. Combined effect of vision and hearing impairment on depression in older adults: Evidence from the English Longitudinal Study of Ageing.
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2015. Subclinical atherosclerosis and increased risk of hearing impairment.
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2010a. The effects of smoking and alcohol consumption on age-related hearing loss: The Blue Mountains Hearing Study.
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2011c. Hearing loss prevalence and risk factors among older adults in the United States.
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2011. The prevalence of hearing impairment and associated risk actors: f The Beaver Dam Offspring Study.
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2015. Age-related hearing impairment and frailty in Alzheimer's disease: Inter connected associations and mechanisms.
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2010. Generational differences in the prevalence of hearing impairment in older adults.
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