The Socioeconomic Impact of Hearing Loss in U.S. Adults

Overview

Journal Otol Neurotol

Specialties Neurology
Otorhinolaryngology

Date 2014 Aug 28

PMID 25158616

Citations 77

Authors

Susan D Emmett

Howard W Francis

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the associations between hearing loss and educational attainment, income, and unemployment/underemployment in U.S. adults.

Study Design: National cross-sectional survey.

Setting: Ambulatory examination centers.

Patients: Adults aged 20 to 69 years who participated in the 1999 to 2002 cycles of the NHANES (National Health and Nutrition Examination Survey) audiometric evaluation and income questionnaire (N = 3,379).

Intervention(s): Pure-tone audiometry, with hearing loss defined by World Health Organization criteria of bilateral pure-tone average of more than 25 dB (0.5, 1, 2, 4 kHz).

Main Outcome Measure(s): Low educational attainment, defined as not completing high school; low income, defined as family income less than $20,000 per year; and unemployment or underemployment, defined as not having a job or working less than 35 hours per week.

Results: Individuals with hearing loss had 3.21 times higher odds of low educational attainment (95% confidence interval [95% CI], 2.20-4.68) compared with normal-hearing individuals. Controlling for education, age, sex, and race, individuals with hearing loss had 1.58 times higher odds of low income (95% CI, 1.16-2.15) and 1.98 times higher odds of being unemployed or underemployed (95% CI, 1.38-2.85) compared with normal-hearing individuals.

Conclusion: Hearing loss is associated with low educational attainment in U.S. adults. Even after controlling for education and important demographic factors, hearing loss is independently associated with economic hardship, including both low income and unemployment/underemployment. The societal impact of hearing loss is profound in this nationally representative study and should be further evaluated with longitudinal cohorts. Received institutional review board approval (National Center for Health Statistics Institutional Review Board Protocol no. 98-12).

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References

Blanchfield B, Feldman J, Dunbar J, Gardner E . The severely to profoundly hearing-impaired population in the United States: prevalence estimates and demographics. J Am Acad Audiol. 2001; 12(4):183-9. View

Curhan S, Eavey R, Wang M, Stampfer M, Curhan G . Body mass index, waist circumference, physical activity, and risk of hearing loss in women. Am J Med. 2013; 126(12):1142.e1-8. PMC: 3848606. DOI: 10.1016/j.amjmed.2013.04.026. View

Agrawal Y, Platz E, Niparko J . Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol. 2008; 30(2):139-45. DOI: 10.1097/MAO.0b013e318192483c. View

Cruickshanks K, Klein R, Klein B, Wiley T, Nondahl D, Tweed T . Cigarette smoking and hearing loss: the epidemiology of hearing loss study. JAMA. 1998; 279(21):1715-9. DOI: 10.1001/jama.279.21.1715. View

Helzner E, Cauley J, Pratt S, Wisniewski S, Zmuda J, Talbott E . Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2006; 53(12):2119-27. DOI: 10.1111/j.1532-5415.2005.00525.x. View

Bess F, Parker R . Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear. 1998; 19(5):339-54. DOI: 10.1097/00003446-199810000-00001. View

Helvik A, Krokstad S, Tambs K . Socioeconomic inequalities in hearing loss in a healthy population sample: The HUNT Study. Am J Public Health. 2009; 99(8):1376-8. PMC: 2707479. DOI: 10.2105/AJPH.2007.133215. View

Resnick M, Gueorguieva R, Carter R, Ariet M, Sun Y, Roth J . The impact of low birth weight, perinatal conditions, and sociodemographic factors on educational outcome in kindergarten. Pediatrics. 1999; 104(6):e74. DOI: 10.1542/peds.104.6.e74. View

Hasson D, Theorell T, Westerlund H, Canlon B . Prevalence and characteristics of hearing problems in a working and non-working Swedish population. J Epidemiol Community Health. 2009; 64(5):453-60. DOI: 10.1136/jech.2009.095430. View

10.

Agrawal Y, Platz E, Niparko J . Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004. Arch Intern Med. 2008; 168(14):1522-30. DOI: 10.1001/archinte.168.14.1522. View

11.

Kramer S, Kapteyn T, Houtgast T . Occupational performance: comparing normally-hearing and hearing-impaired employees using the Amsterdam Checklist for Hearing and Work. Int J Audiol. 2006; 45(9):503-12. DOI: 10.1080/14992020600754583. View

12.

Beckles G, Truman B . Education and income - United States, 2009 and 2011. MMWR Suppl. 2013; 62(3):9-19. View

13.

Kennedy C, McCann D, Campbell M, Law C, Mullee M, Petrou S . Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006; 354(20):2131-41. DOI: 10.1056/NEJMoa054915. View

14.

Brant L, Fozard J . Age changes in pure-tone hearing thresholds in a longitudinal study of normal human aging. J Acoust Soc Am. 1990; 88(2):813-20. DOI: 10.1121/1.399731. View

15.

Pallotto E, Kilbride H . Perinatal outcome and later implications of intrauterine growth restriction. Clin Obstet Gynecol. 2006; 49(2):257-69. DOI: 10.1097/00003081-200606000-00008. View

16.

Lin F, Niparko J, Ferrucci L . Hearing loss prevalence in the United States. Arch Intern Med. 2011; 171(20):1851-2. PMC: 3564588. DOI: 10.1001/archinternmed.2011.506. View

17.

Cooper Jr J . Health and Nutrition Examination Survey of 1971-75: Part I. Ear and race effects in hearing. J Am Acad Audiol. 1994; 5(1):30-6. View

18.

Vogel I, Verschuure H, van der Ploeg C, Brug J, Raat H . Adolescents and MP3 players: too many risks, too few precautions. Pediatrics. 2009; 123(6):e953-8. DOI: 10.1542/peds.2008-3179. View

19.

Moeller M . Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000; 106(3):E43. DOI: 10.1542/peds.106.3.e43. View

20.

Fransen E, Topsakal V, Hendrickx J, Van Laer L, Huyghe J, Eyken E . Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol. 2008; 9(3):264-76. PMC: 2492985. DOI: 10.1007/s10162-008-0123-1. View