Abstract
This population epidemiology study uses data from the NHANES to estimate the number of adults expected to have hearing loss in the next 43 years.
Hearing loss is a major public health issue independently associated with higher health care costs, accelerated cognitive decline, and poorer physical functioning. More than two-thirds of adults 70 years or older in the United States have clinically meaningful hearing loss. With an aging society, the number of persons with hearing loss will grow, increasing the demand for audiologic health care services. A recent National Academies of Science, Engineering, and Medicine (NASEM) report highlighted the critical need to address hearing loss and the limitations of current audiologic health care in the United States. In the present study, we used US population projection estimates with current prevalence estimates of hearing loss to estimate the number of adults expected to have a hearing loss during the next 43 years. These projections can inform policy makers and public health researchers in planning appropriately for the future audiologic hearing health care needs of society.
Methods
The proportion of adults 20 years or older in the United States with hearing loss has been previously estimated using audiometric data from the National Health and Nutrition Examination Survey, a biannual epidemiologic survey of a representative sample of the US noninstitutionalized population. We applied these estimates to 10-year population estimates from 2020 through 2060. Projections were estimated by age decade and severity of hearing loss. Severity of hearing loss was defined as mild (>25 dB through 40 dB) or moderate or greater (>40 dB) and was based on the 4-frequency (0.5, 1.0, 2.0, and 4.0) pure-tone average in the better ear. Institutional review board approval was not required for this study.
Results
The number of adults in the United States 20 years or older with hearing loss (pure tone average, >25 dB) is expected to gradually increase from 44.11 million in 2020 (15.0% of adults ≥20 years) to 73.50 million by 2060 (22.6% of adults ≥20 years) (Table). This increase is greatest among older adults. In 2020, 55.4% of all adults with hearing loss will be 70 years or older, whereas this statistic will be 67.4% in 2060. The number of adults with moderate or greater hearing loss will gradually increase during the next 43 years (Table).
Table. Estimated Projections of the Number of People Expected to Have a Better-Ear Hearing Loss by Severity and Age.
| Better-Ear Hearing Loss Severity | No. With Hearing Loss by Decade, Millionsa | ||||
|---|---|---|---|---|---|
| 2020 | 2030 | 2040 | 2050 | 2060 | |
| Mildb | |||||
| Age, y | |||||
| 20-29 | 0.15 | 0.15 | 0.16 | 0.16 | 0.17 |
| 30-39 | 0.45 | 0.49 | 0.49 | 0.50 | 0.52 |
| 40-49 | 2.49 | 2.82 | 3.04 | 3.06 | 3.13 |
| 50-59 | 4.44 | 4.20 | 4.79 | 5.20 | 5.25 |
| 60-69 | 7.77 | 7.94 | 7.62 | 8.75 | 9.57 |
| 70-79 | 8.90 | 12.06 | 12.50 | 12.23 | 14.27 |
| ≥80 | 4.77 | 7.16 | 10.29 | 11.74 | 12.25 |
| All | 29.02 | 34.85 | 38.92 | 41.69 | 45.19 |
| Moderate or greaterc | |||||
| Age, y | |||||
| 20-29 | 0.03 | 0.03 | 0.03 | 0.03 | 0.03 |
| 30-39 | 0.30 | 0.32 | 0.32 | 0.33 | 0.35 |
| 40-49 | 0.19 | 0.21 | 0.23 | 0.23 | 0.24 |
| 50-59 | 1.18 | 1.12 | 1.27 | 1.38 | 1.40 |
| 60-69 | 2.61 | 2.67 | 2.56 | 2.95 | 3.22 |
| 70 to 79 | 4.75 | 6.43 | 6.66 | 6.52 | 7.61 |
| ≥80 | 6.02 | 9.03 | 12.98 | 14.82 | 15.45 |
| All | 15.10 | 19.83 | 24.08 | 26.28 | 28.31 |
| All hearing loss | 44.11 | 54.68 | 63.00 | 67.97 | 73.50 |
Numbers have been rounded and may not sum the totals.
Indicates hearing loss of greater than 25 dB to 40 dB.
Indicates hearing loss of greater than 40 dB.
Discussion
During the next 43 years, the number of people with hearing loss in the United States is projected to almost double and will outpace the overall population growth rate, given the distribution shift toward older adults. Furthermore, by 2060, the number of people with a moderate or greater hearing loss will exceed the number of people who have a mild loss today. A recent NASEM report made recommendations to improve access to interventions and hearing health care services. However, these recommendations need to be approached by policy makers in the context of the expected rapid growth in the number of individuals with hearing loss during the next several decades. The increased need for affordable interventions and accessibility to trained hearing specialists will require novel and cost-effective approaches to audiologic health care.
One limitation of the present study is the assumption that current prevalence rates of hearing loss by age decade will remain relatively constant during the next 40 years and beyond. This assumption is reasonable given that the primary risk factors for acquired (noncongenital) hearing loss include age, sex, race, and genetic predispositions. Furthermore, prevalence rates by age have only minimally changed during the past 50 years, despite general improvements in industrial noise exposure (a risk factor for acquired hearing loss). Given the projected increase in the number of people with hearing loss that may strain future resources, greater attention to primary (reducing incidence of hearing loss), secondary (reducing progression of hearing loss), and tertiary (treating hearing loss to reduce functional sequelae) prevention strategies is needed to address this major public health issue.
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