Abstract
This cross-sectional study characterizes the prevalence of age-related hearing loss in people 80 years and older using data from the National Health and Nutrition Examination Survey.
Age-related hearing loss (HL), a common and undertreated condition, has been linked to morbid conditions, including dementia, cognitive impairment,1 and depression.2 While studies have measured the prevalence of HL in general,3 or in the older old (≥80 years) as a single group,4,5 an accurate population-level estimate does not exist for those 80 years and older. This is because population-level databases either exclude or mask upper age extremes to protect anonymity. This precludes specifically studying HL epidemiology in older old individuals, the very group most affected by HL.
We obtained access to the true age of older old individuals in the National Health and Nutrition Examination Survey (NHANES) through a specialized security clearance process. To our knowledge, this represents the first nationally representative characterization of HL prevalence in the older old population.
Methods
Participant data were taken from NHANES, a cross-sectional representative study of noninstitutionalized American civilians. Audiometric testing for those 80 years and older was available in the 2005-2006, 2009-2010, and 2011-2012 cycles (n = 621). Prevalence data from the analyzed cycles were multiplied by a scaling factor based on the 2018 US census data to estimate prevalence in the overall population. Demographic data included age, sex, and hearing aid use (>5 hours/day). The Columbia University institutional review board did not consider it to be research involving human subjects under the Code of Federal Regulations, Title 45, Part 46. Participant written informed consent was waived as the data were in deidentified form.
The public data set groups upper ages into a single age group of either 80 years and older or 85 years and older to reduce the risk of identifying participants and breaching anonymity. To gain access to the restricted data set that includes true age, investigators obtained Special Sworn Status through a months-long federal security clearance process (https://www.census.gov/about/adrm/fsrdc/about/secure_rdc.html). Analysis groups were required to have 5 or more individuals per table cell.
Air-conduction audiometry thresholds were recorded at 0.5, 1, 2, 4, 6, and 8 kHz in decibel (dB) hearing level. The 4-frequency better-ear pure-tone average (PTA) was calculated by averaging thresholds at 0.5, 1, 2, and 4 kHz. Hearing loss was defined as a PTA greater than 25 dB. Sample weighting, per NHANES protocols, was used.
Participants were grouped into 5-year age brackets. Analysis was performed in Stata version 16 (StataCorp) between June and December 2019 on monitored US Census Bureau Federal Statistical Research Data Center computers (New Haven, Connecticut, and New York, New York).
Results
A total of 621 participants in NHANES were 80 years or older, representing a weighted 10 600 197 Americans. The mean (SD; range) age was 84.2 (4.0; 80-104) years and 4 027 144 (38.0%) were male. Hearing aid use increased from 1 045 194 (15.5%) among those aged 80 84 years to 79 385 (29.0%) of those 95 years and older (Table 1).
Table 1. Demographic Characteristics and Hearing Aid Use, National Health and Nutrition Examination Survey (NHANES; 2005-2006, 2009-2010, and 2011-2012 Cycles).
| Characteristic | Age bracket | ||||
|---|---|---|---|---|---|
| 80-84 y | 85-89 y | 90-94 ya | ≥95 ya | Total | |
| Unweighted No. | 393 | 157 | 57 | 14 | 621 |
| Weighted No.b | 6 740 882 | 2 613 429 | 970 706 | 275 179 | 10 600 197 |
| Male | 2 620 979 (38.9) | 1 051 607 (40.2) | 354 558 (28.5) | 4 027 144 (38.0) | |
| Hearing aid use | 1 045 194 (15.5) | 523 471 (20.0) | 222 724 (22.9) | 79 385 (29.0) | 1 870 775 (17.6) |
Per US Census Bureau Research Data Center regulation, ages must be binned to have at least 5 individuals per unweighted table cell to protect anonymity.
Per NHANES protocols, data were weighted and scaled to the US population.
For those 80 years and older, the average PTA in participants’ better-hearing ear was 38.9 (95% CI, 37.8-40.0) dB. Of those surveyed, 8.6 million participants (81.4%) had HL (PTA >25 dB). The mean PTA was 36.6 (95% CI, 35.3-37.9) dB for participants aged 80 to 84 years, 40.9 (95% CI, 38.7-43.1) dB for those aged 85 to 90 years, 45.8 (95% CI, 42.1-49.5) dB for those aged 90 to 94 years, and 50.9 (95% CI, 44.5-57.4) dB for those 95 years or older. Prevalence of HL (PTA >25 dB) was 5 206 081 of 6 740 882 participants (77.2%) aged 80 to 84 years, 2 251 108 of 2 613 429 participants (86.1%) aged 85 to 89 years, and 1 168 177 of 1 245 885 participants (93.8%) for those 90 years and older (Table 2).
Table 2. Hearing Loss Prevalence in the Older Old, National Health and Nutrition Examination Survey (2005-2006, 2009-2010, and 2011-2012 Cycles)a.
| Hearing loss category | Age bracket | ||||
|---|---|---|---|---|---|
| 80-84 y | 85-89 y | 90-94 yb | ≥95 yb | Total | |
| Pure-tone average in better-hearing ear, mean (95% CI) | 36.6 (35.3-37.9) | 40.9 (38.7-43.1) | 45.8 (42.1-49.5) | 50.9 (44.5-57.4) | 38.9 (37.8-40.0) |
| US adults with hearing loss, No. | |||||
| None (≤25 dB) | 1 534 801 | 362 320 | 77 709 | 1 974 830 | |
| Any (≥26 dB) | 5 206 081 | 2 251 108 | 1 168 177 | 8 625 367 | |
| Mild (26-40 dB) | 2 622 782 | 901 539 | 328 498 | 3 852 819 | |
| Moderate (41-55 dB) | 2 037 847 | 965 744 | 499 727 | 3 503 319 | |
| Moderately severe or worse (≥56 dB) | 545 452 | 383 825 | 339 952 | 1 269 229 | |
| US adults with hearing loss, % | |||||
| None (≤25 dB) | 22.8 | 13.9 | 6.2 | 18.6 | |
| Any (≥26 dB) | 77.2 | 86.1 | 93.8 | 81.4 | |
| Mild (26-40 dB) | 38.9 | 34.5 | 26.4 | 36.4 | |
| Moderate (41-55 dB) | 30.2 | 37 | 40.1 | 33.1 | |
| Moderately severe or worse (≥56 dB) | 8.1 | 14.7 | 27.3 | 12 | |
Hearing loss category was determined by the pure-tone average in the better-hearing ear.
Per US Census Bureau Research Data Center regulation, ages must be binned to have at least 5 individuals per unweighted table cell to protect anonymity.
Discussion
Hearing loss was highly prevalent, at 81.4% (8 625 367 of 10 600 197), in those 80 years or older, similar to prior studies using NHANES public data.3 Prevalence increased with age, from 77.2% (5 206 081 of 6 740 882) in those aged 80 to 85 years to 93.8% (1 168 177 of 1 245 885) in those 90 years and older. Surprisingly, 6.2% (77 709 of 1 245 885) of those 90 years and older had normal hearing. Similar to prior studies, hearing aids were underused,6 with less than one-third of those aged 95 years and older surveyed wearing them despite 94% HL prevalence.
One limitation of this study is that NHANES is cross-sectional and does not reflect aging over time. A second limitation is that, since NHANES only represents the noninstitutionalized population, it may underestimate HL in older old individuals. Additionally, our calculations are based on a relatively small sample size of 621 individuals.
In conclusion, prevalence of HL predictably increased with age and was nearly universal by age 100 years. Despite the high prevalence of HL, hearing aid use among the older old remained very low. These statistics will inform the ongoing national debate on hearing health care in the population most affected by HL.
References
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