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. 2023 Oct 27;13:18434. doi: 10.1038/s41598-023-44735-x

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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The potential mechanisms linking age-related hearing impairment (ARHI) and body mass index (BMI). For two exposures increasing the risk of death, conditioning on survival may induce an association between the previously uncorrelated ARHI (and its genetic proxy G) and age-related health outcomes (panel A). Additionally, conditioning on survival may induce an association between the genetic instrument G and any confounders U (e.g., Alzheimer’s disease) of the ARHI–BMI association (panel B), even in the absence of second exposure: age-related health outcomes.