Elham Mahmoudi1,2, Tanima Basu2, Kenneth Langa2,3,4,5, Michael M McKee1,2, Philip Zazove1, Neil Alexander4,6, Neil Kamdar2,7,8,9. 1. Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. 3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 4. Institute for Social Research, University of Michigan, Ann Arbor, Michigan. 5. Veteran Affairs (VA) Center for Clinical Management Policy Research, Ann Arbor, Michigan. 6. Institute of Gerontology, University of Michigan, Ann Arbor, Michigan. 7. Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan. 8. Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan. 9. Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Abstract
OBJECTIVE: To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN: Retrospective cohort study. SETTING: We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan-Meier curves to examine unadjusted disease-free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age-related/HL-associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS: The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT: Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION: Use of HAs. RESULTS: Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = -0.024 to -0.016). Approximately 13.6% of whites (95% CI = 0.13-0.14) vs 9.8% of blacks (95% CI = 0.09-0.11) and 6.5% of Hispanics (95% CI = 0.06-0.07) used HAs. The risk-adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76-0.89), 0.89 (95% CI = 0.86-0.93), and 0.87 (95% CI = 0.80-0.95), respectively. CONCLUSIONS: Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362-2369, 2019.
OBJECTIVE: To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN: Retrospective cohort study. SETTING: We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan-Meier curves to examine unadjusted disease-free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age-related/HL-associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS: The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT: Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION: Use of HAs. RESULTS: Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = -0.024 to -0.016). Approximately 13.6% of whites (95% CI = 0.13-0.14) vs 9.8% of blacks (95% CI = 0.09-0.11) and 6.5% of Hispanics (95% CI = 0.06-0.07) used HAs. The risk-adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76-0.89), 0.89 (95% CI = 0.86-0.93), and 0.87 (95% CI = 0.80-0.95), respectively. CONCLUSIONS: Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362-2369, 2019.
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