Results of a large, retrospective cohort study published in JAMA Otolaryngology–Head & Neck Surgery found that untreated hearing loss was associated with increased morbidity across a broad spectrum of disorders.
Hearing loss affects more than 50% of Americans aged 60 years or older, and evidence suggests a link between hearing loss and cognitive decline. Given that hearing loss is treatable, determining the association between this condition and other comorbidities is vital, particularly as 73 million Americans are projected to have hearing loss by 2060.
Jennifer A. Deal, PhD, from the Department of Epidemiology and the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, and colleagues used OptumLabs administrative claims data from more than 200,000 adults. Patients were aged 50 years or older, with 2 or more claims for hearing loss within 2 consecutive years, and without evidence of hearing device use. These claims were used to identify incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke between January 1, 2000, and December 31, 2016.
The relative risk (RR) at 5 years was strongest for dementia (RR, 1.50) and depression (RR, 1.41). A diagnosis of hearing loss increased the risk for all outcomes by 20% to 50%, with the exception of fracture at 10 years and myocardial infarction at 5 years, as compared with no evidence of hearing loss. At 10 years, the risk associated with hearing loss was 3.20 per 100 persons for dementia, 6.88 per 100 persons for depression, 3.57 per 100 persons for falls, 1.05 per 100 persons for myocardial infarction, and 2.69 per 100 persons for stroke.
The absolute risk for comorbid conditions increased over time, with the greatest risk found for depression, falls, and dementia for the cohort observed for 10 years.
The limitations of this study are those inherent to using a claims database, including the failure to identify all cases of hearing loss, particularly mild cases, and the possibility of detection bias, in which those who seek diagnosis for hearing loss may interact more frequently with the healthcare system. As data on mortality were not available in this database, the ability to account for the competing risk for death was not possible. Furthermore, the database population was primarily white and was wealthier than the general American population, so the results may not universally applicable.
The authors call for future studies that explore the mechanisms involved in the association between hearing loss and comorbidities and determine whether hearing loss treatment can reduce risks in middle-aged and older adults.
Deal JA, Reed NS, Kravetz AD, et al. Incident hearing loss and comorbidity. A longitudinal administrative claims study [published online November 8, 2018]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2018.2876