Christopher W Noel1, Florence Mok1, Vincent Wu1, Antoine Eskander1, Christopher M K L Yao1, Stephen W Hwang1, Myrna Lichter1, Melissa Reekie1, Sean Smith1, Ian Syrett1, Molly Zirkle1, Vincent Lin2, John M Lee2. 1. Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont. 2. Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont. leejo@smh.ca Vincent.lin@sunnybrook.ca.
Abstract
BACKGROUND: Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population. METHODS: We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population. RESULTS: Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37-58) years. The median duration of homelessness was 24 (IQR 6-72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%-49.3%) and 51.9% (95% CI 42.2%-61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%-49.3% v. 19.2%, 95% CI 16.9%-21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%-61.4% v. 35.5%, 95% CI 33.1%-37.7%) were substantially higher than in the general Canadian population. INTERPRETATION: Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population. METHODS: We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population. RESULTS: Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37-58) years. The median duration of homelessness was 24 (IQR 6-72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%-49.3%) and 51.9% (95% CI 42.2%-61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%-49.3% v. 19.2%, 95% CI 16.9%-21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%-61.4% v. 35.5%, 95% CI 33.1%-37.7%) were substantially higher than in the general Canadian population. INTERPRETATION: Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening. Copyright 2020, Joule Inc. or its licensors.
Authors: Vincent Wu; Christopher W Noel; David Forner; Florence Mok; Molly Zirkle; Antoine Eskander; Vincent Lin; John M Lee Journal: J Otolaryngol Head Neck Surg Date: 2020-07-09