Abstract
This secondary analysis of the National Health and Nutrition Examination Survey examines the prevalence and correlates of hearing loss among older adults with and without heart failure in the United States.
Hearing loss is common among older adults in the United States and is associated with coronary heart disease and its risk factors. Yet, the prevalence of hearing loss among adults with heart failure (HF) has not been well described.
Heart failure is a chronic, incurable disease and is the leading cause of hospitalization among older adults in the United States. To mitigate disease progression, patients are asked to take multiple medications and make lifestyle changes. Given the high degree of self-care that HF imposes, it is imperative that patients can hear physician recommendations. Herein, we examined the prevalence and correlates of hearing loss among older adults with and without HF in the United States.
Methods
We analyzed data from adults 70 years and older from the 2005 to 2006 and 2009 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a series of ongoing cross-sectional surveys of the civilian noninstitutionalized US population. Participants had HF if they answered yes to, “Has a doctor ever diagnosed you with heart failure?” The World Health Organization criteria were used to classify the severity of hearing loss based on the pure-tone average (0.5-4.0 kHz) in the better ear. No hearing loss was 25 dB or less; mild, more than 25 but 40 dB or less; moderate, more than 40 but 60 dB or less; severe, more than 60 but 80 dB or less; and profound, more than 80 dB. Population projections were used to estimate the number of older adults with HF and hearing loss. Multivariable logistic regression was used to estimate the association between HF and hearing loss. The study was approved by the National Center for Health Statistics institutional review board, and NHANES obtained written informed consent from all participants.
Results
Participants with HF were older, had more cardiovascular comorbidities, and had a higher burden of hearing loss compared with those without HF (Table 1). Overall, the prevalence of hearing loss among participants with HF was 74.4% and the prevalence of hearing loss among those without HF was 63.3% (difference, 11.1%; 95 CI%, 1.0%-20.8%). Extrapolating these estimates to the US population, 1.7 million older adults with HF currently have hearing loss and by 2020, 2.4 million will.
Table 1. Characteristics of the Study Population by Self-reported Heart Failure Status From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Surveya.
| Characteristics | Prevalence, % (95% CI) | ||
|---|---|---|---|
| Overall | Participants Without Heart Failure | Participants With Heart Failure | |
| Age group, y | |||
| 70-74 | 36.8 (33.4-40.3) | 37.7 (34.0-41.5) | 28.7 (20.1-39.1) |
| 75-79 | 26.4 (24.1-28.9) | 26.9 (24.4-29.6) | 22.5 (17.0-29.2) |
| ≥80 | 36.8 (34.2-39.4) | 35.4 (32.9-38.1) | 48.8 (38.7-59.0) |
| Sex | |||
| Male | 41.3 (39.2-43.3) | 40.7 (38.5-42.9) | 46.7 (40.0-53.5) |
| Female | 58.7 (56.7-60.8) | 59.3 (57.1-61.5) | 53.3 (46.5-60.0) |
| Race/ethnicity | |||
| Non-Hispanic white | 83.4 (79.7-86.5) | 83.6 (80.0-86.6) | 83.2 (77.0-87.9) |
| Non-Hispanic black | 8.2 (6.3-10.5) | 7.9 (6.0-10.3) | 10.0 (6.8-14.5) |
| Hispanic | 5.5 (3.6-8.1) | 5.5 (3.7-8.1) | 4.7 (2.3-9.1) |
| Other | 3.0 (2.1-4.2) | 3.1 (2.1-4.4) | 2.2 (1.0-5.9) |
| Education level | |||
| Less than high school | 29.8 (25.9-34.0) | 29.4 (25.3-34.0) | 30.9 (24.9-37.7) |
| High school | 28.0 (25.7-30.3) | 27.5 (25.3-29.8) | 33.2 (25.4-42.0) |
| Some college or higher | 42.3 (37.4-47.3) | 43.1 (38.3-48.0) | 35.9 (26.5-46.6) |
| Income <$20 000/y | 25.9 (22.9-29.2) | 25.6 (22.4-29.0) | 29.2 (23.0-36.4) |
| Marital status | |||
| Married or living with a partner | 55.3 (51.2-59.4) | 55.9 (52.1-59.6) | 50.3 (38.4-62.1) |
| Widowed, separated, or divorced | 42.6 (38.7-46.5) | 42.0 (38.4-45.6) | 48.3 (37.1-59.7) |
| Never married | 2.1 (1.5-2.9) | 2.1 (1.5-3.0) | 1.4 (0.3-5.8) |
| Smoking status | |||
| Never | 49.6 (47.1-52.2) | 49.5 (46.9-52.1) | 50.6 (40.4-60.7) |
| Former | 43.4 (40.4-46.5) | 43.6 (40.7-46.6) | 41.1 (31.5-51.6) |
| Current | 7.0 (5.7-8.4) | 6.9 (5.6-8.4) | 8.2 (4.7-13.9) |
| Coronary heart disease | 18.1 (16.4-19.8) | 14.1 (12.3-16.1) | 58.0 (48.5-66.9) |
| Diabetes | 28.1 (25.8-30.5) | 26.8 (24.2-29.5) | 41.7 (33.6-50.4) |
| Hypertension | 62.0 (59.2-64.7) | 61.1 (58.3-64.0) | 70.6 (63.0-77.2) |
| Chronic kidney disease | 4.6 (3.6-5.7) | 3.6 (2.6-5.0) | 14.2 (8.5-22.8) |
| Stroke | 10.1 (8.5-12.1) | 8.8 (7.4-10.4) | 24.7 (17.0-34.3) |
| Hearing lossb | |||
| None (≤25 dB) | 35.7 (31.2-40.4) | 36.7 (31.8-41.9) | 25.8 (19.1-33.9) |
| Mild (>25 to ≤40 dB) | 35.7 (32.2-39.4) | 35.1 (31.1-39.4) | 41.9 (35.3-48.7) |
| Moderate (>40 to ≤60 dB) | 23.7 (21.6-26.0) | 23.8 (21.4-26.3) | 22.0 (16.6-28.5) |
| Severe (>60 to ≤80 dB) | 4.4 (3.4-5.6) | 4.0 (2.9-5.3) | 9.5 (5.9-15.1) |
| Profound (>80 dB) | 0.5 (0.2-1.0) | 0.4 (0.2-1.0) | 1.0 (0.1-5.3) |
| Hearing aid usec | 12.8 (11.5-14.3) | 3.7 (1.7-7.9) | 16.3 (11.8-22.1) |
| Exposure to noised | 49.3 (46.6-51.9) | 48.7 (46.0-51.4) | 54.5 (48.0-60.9) |
| Exposure to noise on the jobe | 30.6 (28.1-33.3) | 29.9 (27.1-32.8) | 38.3 (32.0-45.1) |
| Firearm usef | 36.2 (33.4-39.0) | 35.9 (33.0-38.9) | 38.8 (33.0-45.0) |
Prevalence estimates were computed using Mobile Examination Center examination weights to provide estimates for the total US population and are age standardized to the US 2010 Census population.
Hearing loss was defined as pure tone average (at 0.5, 1, 2, and 4 kHz) of above 25 dB in the better ear.
Hearing aid use was defined as use of hearing aids for 5 or more hours a week in the past 12 months.
Exposure to noise was defined as exposure to loud noise or music for 5 or more hours a week outside of a job.
Exposure to noise on the job was defined as exposure to loud noise for 5 or more hours a week on the job.
Firearm use was defined as use of firearms for shooting, hunting, or other purposes.
The association between HF and hearing loss was also examined (Table 2). Participants with HF had 1.67 higher odds of mild or greater hearing loss (odds ratio [OR], 1.67; 95% CI, 1.02-2.72) compared with those without HF. Although the point estimate and upper bound of the confidence interval remained similar, this association was not significant in a fully adjusted model (adjusted OR [aOR], 1.65; 95% CI, 0.87-3.17). In this model, being 80 years or older (aOR, 4.65; 95% CI, 3.59-5.99), having less education (aOR, 1.9; 95% CI, 1.45-2.48), and greater noise exposure (aOR, 1.45; 95% CI, 1.01-2.07) were independently associated with mild or greater hearing loss.
Table 2. Association Between Heart Failure and Hearing Loss Among Older Adults From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Survey.
| Hearing Lossa | OR (95% CI) |
|---|---|
| Mild or greater | |
| Model 1b | 1.67 (1.02-2.72) |
| Model 2c | 1.65 (0.86-3.17) |
| Moderate or greaterd | |
| Model 1b | 1.21 (0.87-1.71) |
| Model 2c | 0.97 (0.65-1.44) |
Abbreviations: OR, odds ratio; PTA, pure tone average.
Hearing loss was defined as PTA (at 0.5, 1, 2, and 4kHz) of above 25 dB in the better ear.
Model 1: heart failure alone.
Model 2 (adjusted model): heart failure status plus age, sex, race/ethnicity, education, income, marital status, coronary heart disease, diabetes, hypertension, stroke, chronic kidney disease, smoking status, and noise exposure.
Moderate or greater hearing loss was defined as PTA (at 0.5, 1, 2, and 4kHz) of above 40 dB in the better ear.
Discussion
Overall, 75% of adults 70 years or older with HF have hearing loss. Although hearing loss was more common among adults with HF compared with those without it, HF was not independently associated with hearing loss after accounting for demographic and clinical characteristics. Future studies might examine potential correlates of hearing loss that we were unable to study, including ejection fraction and HF-specific medications like furosemide, which has ototoxic properties.
Notably, only 16.3% of participants with HF and hearing loss wore hearing aids, with the majority having moderate or greater hearing loss. Research suggests, however, that mild hearing loss also benefits from hearing aids. Since patients with HF are frequently in noisy hospitals and clinics where they receive myriad instructions about disease management, it seems likely that untreated hearing loss could impair patient-physician communication and ultimately HF self-care. Our findings suggest that audiometric screening and treatment of hearing loss among older adults with HF is warranted, in addition to improved communication techniques for physicians.
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