Abstract
This cohort study examines trends in hearing aid ownership in the US.
Hearing loss is common among older adults, and those with hearing loss have greater levels of health care use and are more likely to have dementia.1,2 However, cross-sectional, nationally representative data from the 1999 through 2006 cycles of the National Health Examination and Nutrition Study suggest that fewer than 20% of adults with hearing loss in the US report hearing aid use.3 High cost, poor access, and stigma have previously been reported as barriers to hearing aid uptake in the US.4 To date, most estimates of hearing aid use in the US are cross-sectional, and there is a paucity of studies examining trends in hearing aid ownership in nationally representative longitudinal data sets.
Methods
This study analyzed data from the 2011 (n = 6180), 2015 (n = 6521), and 2018 (n = 4752) cycles of the National Health Aging and Trends Study, a longitudinal study of Medicare beneficiaries that is continuously replenished to maintain national representation. Because it was an analysis of secondary, deidentified data in a publicly available data set, it did not qualify as human participants research. During the in-home annual study visit, participants were asked “in the last month, [have you/has (he/she)] used a hearing aid or other hearing device?” Participants can respond yes or no. Survey weighting was used to account for sampling design and study attrition according to National Health Aging and Trends Study guidelines. Data were analyzed using Stata, version 16 (StataCorp).
Results
The overall proportion of participants 70 years and older who own and use hearing aids rose from 15.0% in 2011 to 16.9% in 2015 and 18.5% in 2018 (Table). As age increased, so did the proportion of older adults who owned hearing aids. Notably, fewer Black Americans owned and used hearing aids across time and experienced a smaller overall increase in the proportion who owned and used hearing aids over the 8-year period compared with White Americans (+0.8% vs +4.3%). Black women experienced the smallest growth in hearing aid use across subgroups during the 8-year period (Figure). In contrast to White men, who saw a 28.7% increase in hearing aid use, Black women saw only 5.8% growth over the same 8-year period. Lastly, older adults living at less than 100% of the federal poverty level experienced an overall decrease in proportion of hearing aid ownership and use from 12.4% in 2011 to 10.8% in 2018, whereas older adults living at 200% or above the poverty line saw an increase from 16.4% in 2011 to 21.2% in 2018.
Table. Weighted Number and Proportion of Adults 70 Years and Older Using Hearing Aids in the United States From 2011 to 2018a,b.
| Characteristic | 2011 | 2015 | 2018 | Percentage change, 2011-2018 | |||
|---|---|---|---|---|---|---|---|
| No. (95% CI), millions | Percentage (95% CI) | No. (95% CI), millions | Percentage (95% CI) | No. (95% CI), millions | Percentage (95% CI) | ||
| All | 4.0 (3.7 to 4.2) | 15.0 (14.0 to 15.9) | 5.0 (4.7 to 5.3) | 16.9 (15.9 to 17.9) | 6.1 (5.7 to 6.6) | 18.5 (17.2 to 19.7) | 23.3 |
| Race | |||||||
| White | 3.5 (3.3 to 3.8) | 16.6 (15.5 to 17.7) | 4.5 (4.2 to 4.8) | 19.2 (18.0 to 20.4) | 5.5 (5.1 to 5.9) | 20.9 (19.4 to 22.4) | 25.9 |
| Black | 0.1 (0.1 to 0.1) | 5.1 (3.8 to 6.5) | 0.1 (0.1 to 0.1) | 4.7 (3.5 to 5.9) | 0.1 (0.1 to 0.2) | 5.9 (4.2 to 7.6) | 15.2 |
| Sex | |||||||
| Male | 2.0 (1.9 to 2.2) | 18.7 (17.1 to 20.3) | 2.8 (2.6 to 3.0) | 21.9 (20.2 to 23.6) | 3.4 (3.1 to 3.8) | 24.1 (21.9 to 26.3) | 28.6 |
| Female | 1.9 (1.7 to 2.1) | 12.2 (11.1 to 13.3) | 2.2 (2.0 to 2.4) | 13.1 (12.0 to 14.2) | 2.7 (2.4 to 2.9) | 14.1 (12.6 to 15.6) | 15.4 |
| Incomec | |||||||
| Less than 100% of the poverty line | 0.7 (0.6 to 0.8) | 12.4 (10.7 to 14.1) | 0.5 (0.4 to 0.6) | 10.3 (8.6 to 11.9) | 0.5 (0.4 to 0.7) | 10.8 (8.4 to 13.1) | −13.0 |
| 100%-199% Of the poverty line | 1.0 (0.8 to 1.1) | 13.8 (12.2 to 15.5) | 1.0 (0.9 to 1.1) | 14.5 (12.7 to 16.3) | 1.0 (0.8 to 1.2) | 15.4 (12.9 to 17.9) | 11.3 |
| 200% Or more of the poverty line | 2.0 (1.8 to 2.2) | 16.2 (14.8 to 17.7) | 3.3 (3.0 to 3.5) | 19.7 (18.2 to 21.1) | 4.5 (4.1 to 4.8) | 21.2 (19.5 to 23.0) | 30.6 |
Data derived from the National Health Aging and Trends Study (NHATS) 2011, 2015, and 2018 cycles.
All proportions are age-adjusted according to the NHATS weighted sample size and age distribution.
Poverty line for those 65 years and older in a 2-person household as defined by the US Census.
Figure. Proportion of Hearing Aid Use Among Adults 70 Years and Older by Sex and Race From 2011 to 2018.
All proportions are age-adjusted according to the National Health Aging and Trends Study weighted sample size and age distribution.
Discussion
In a nationally representative sample of adults older than 70 years, the proportion who reported owning and using their hearing aids increased 23.3% from 2011 to 2018. However, the overall trend of growth in hearing aid use masks substantial variation by race and sex. Moreover, lower-income participants experienced a decrease in proportional ownership and use of hearing aids. These data corroborate and build on previous cross-sectional findings of disparities5 in hearing care by offering a longitudinal analysis in a nationally representative sample of older adults in the US.
Potential factors contributing to the overall trend may include the greater enrollment in Medicare Advantage plans with hearing benefits6 and pursuit of hearing care following popular media coverage of the association of hearing loss with dementia.1,2 This study is limited by a lack of sufficient measures to examine hearing aid use specific to those with hearing loss and lack of description of the regularity of use or type of device. While the prevalence of hearing loss is lower among women vs men and Black vs White Americans, growth trends should be proportional unless physical or financial barriers, such as cost of devices, or stigma associated with using the devices is experienced disproportionately across sex and race. Future work would benefit from including more specific questions about the type of device and frequency of use.
References
- 1.Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol. 2011;68(2):214-220. doi: 10.1001/archneurol.2010.362 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Reed NS, Altan A, Deal JA, et al. Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngol Head Neck Surg. 2019;145(1):27-34. doi: 10.1001/jamaoto.2018.2875 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Arch Intern Med. 2012;172(3):292-293. doi: 10.1001/archinternmed.2011.1408 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.McKee MM, Choi H, Wilson S, DeJonckheere MJ, Zazove P, Levy H. Determinants of hearing aid use among older Americans With Hearing Loss. Gerontologist. 2019;59(6):1171-1181. doi: 10.1093/geront/gny051 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Nieman CL, Marrone N, Szanton SL, Thorpe RJ Jr, Lin FR. Racial/ethnic and socioeconomic disparities in hearing health care among older Americans. J Aging Health. 2016;28(1):68-94. doi: 10.1177/0898264315585505 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Willink A, Reed NS, Swenor B, Leinbach L, DuGoff EH, Davis K. Dental, vision, and hearing services: access, spending, and coverage for Medicare beneficiaries. Health Aff (Millwood). 2020;39(2):297-304. doi: 10.1377/hlthaff.2019.00451 [DOI] [PMC free article] [PubMed] [Google Scholar]