Dane J Genther1, Joshua Betz2, Sheila Pratt3, Steven B Kritchevsky4, Kathryn R Martin5, Tamara B Harris6, Elizabeth Helzner7, Suzanne Satterfield8, Qian-Li Xue9, Kristine Yaffe10, Eleanor M Simonsick11, Frank R Lin12. 1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. dgenthe2@jhmi.edu. 2. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pennsylvania. Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania. 4. Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. J. Paul Sticht Center on Aging, Winston-Salem, North Carolina. 5. Department of Epidemiology, University of Aberdeen, UK. 6. Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland. 7. Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn. 8. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis. 9. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 10. Department of Epidemiology and Biostatistics, Department of Psychiatry and Department of Neurology, University of California, San Francisco. 11. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Intramural Research Program, National Institute on Aging, Bethesda, Maryland. 12. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
BACKGROUND: Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults. METHODS: Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear. RESULTS: Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL). CONCLUSIONS: HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.
BACKGROUND:Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults. METHODS: Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear. RESULTS: Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL). CONCLUSIONS: HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.
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