Association Between Social Determinants of Health and Hearing Loss and Hearing Intervention in Older US Adults

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.