Swenor BK, Ramulu PY, Willis JR, Friedman D, Lin FR. The Prevalence of Concurrent Hearing and Vision Impairment in the United States. JAMA Intern Med. 2013;173(4):312-313. doi:10.1001/jamainternmed.2013.1880
Author Affiliations: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (Ms Swenor and Drs Friedman and Lin), and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute (Ms Swenor and Drs Ramulu, Willis, and Friedman), and Department of Otolaryngology–Head and Neck Surgery (Dr Lin), Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
The prevalence of dual sensory impairment (DSI) in hearing and vision has been estimated previously using self-reported data,1 nonrepresentative population samples,2 or populations outside of the United States.3 These estimates may not accurately reflect the true burden of DSI in the United States. We determined the prevalence of DSI using objective assessments of hearing and vision in a nationally representative sample of US adults.
We analyzed data from the 1999-2006 cycles of the National Health and Nutritional Examination Surveys (NHANES), a study designed to assess the health of a nationally representative sample of noninstitutionalized, civilian US residents.4
Air conduction pure-tone audiometry performed in a sound attenuating booth was administered to a half-sample of all participants aged 20 to 69 years from 1999 through 2004 and all participants 70 years or older from 2005 through 2006 according to established NHANES protocols. A speech-frequency pure-tone average (average of hearing thresholds at 0.5, 1, 2, and 4 kHz) greater than 25 dB in the better ear was defined as hearing impairment per World Health Organization criteria.5
For all participants 20 years or older from 1999 through 2006, visual acuity was determined for each eye using the individual's presenting correction (if any) and reassessed after autorefraction in eyes with a presenting acuity worse than 20/25.4 Visual impairment was defined by having a postautorefraction visual acuity worse than 20/40 in the better-seeing eye.
Four categories of sensory impairment were defined: DSI (concurrent hearing and vision impairment); hearing impairment (HI); vision impairment (VI); and no impairment (neither hearing nor vision impairment). Prevalence estimates were determined by age decade and sex. The US population counts were estimated using the midpoint of population totals in each NHANES cycle and averaged across combined cycles when appropriate. We accounted for the complex sampling design in all analyses by using sample weights according to National Center for Health Statistics guidelines.
We estimate that from 1999 through 2006 approximately 1.5 million Americans 20 years or older had DSI, with nearly all affected individuals being older adults (Table). For individuals younger than 70 years, the prevalence of DSI was less than 1%, but among individuals 80 years or older, 11.3% had DSI, and only 19% remained free of having any sensory impairment. Prevalence rates for DSI were not substantively different between men and women at any age decade. At each age decade, the prevalence of HI was greater in men than in women; however, the prevalence of VI was not different between men and women at any age.
To our knowledge, this study presents the first national prevalence estimates of DSI in the United States based on objective data. Our results demonstrate that 1 in 9, or 11.3%, of all adults 80 years or older has prevalent DSI. This estimate is substantially higher than previous national estimates of DSI based on self-reported impairment among older adults1 (6.6%). Other estimates of DSI prevalence using objective assessments were based on a cohort of veterans2 or an Australian population3 and may not be generalizable to US adults.
Despite the relatively high prevalence in older adults, there is an inadequate understanding of the impact of DSI on cognition and physical functioning. Concurrent vision impairment could potentially accelerate the rate of cognitive decline and dementia previously reported in individuals with hearing impairment alone.6 There is also a lack of research examining how to effectively treat or rehabilitate older adults with DSI. Interdisciplinary, collaborative research efforts between ophthalmologists, otolaryngologists, and geriatricians are urgently needed to investigate the impacts of DSI, as well as to examine possible treatment and rehabilitative strategies in older adults.
Correspondence: Ms Swenor, Wilmer Eye Institute, School of Medicine, The Johns Hopkins Hospital, Woods 172, 600 N Wolfe St, Baltimore, MD 21287 (firstname.lastname@example.org).
Published Online: January 21, 2013. doi:10.1001/jamainternmed.2013.1880
Author Contributions: Ms Swenor had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Swenor, Ramulu, Friedman, and Lin. Acquisition of data: Ramulu, Willis, and Friedman. Analysis and interpretation of data: Swenor, Willis, Friedman, and Lin. Drafting of the manuscript: Swenor. Critical revision of the manuscript for important intellectual content: Swenor, Ramulu, Willis, Friedman, and Lin. Statistical analysis: Swenor, Willis, Friedman, and Lin. Study supervision: Ramulu, Friedman, and Lin.
Conflict of Interest Disclosures: Dr Lin is a consultant to Pfizer and Cochlear Corp.
Funding/Support: This work was supported by grant T32AG000247 from the National Institutes of Aging, Research to Prevent Blindness Special Scholar Award, and NIH grant EY018595. Dr Lin was supported by NIH K23DC011279 and a Triological Society/American College of Surgeons Clinician Scientist Award.
Role of the Sponsors: The funders had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.