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Figure.  Proportion of Hearing Aid Use Among Adults 70 Years and Older by Sex and Race From 2011 to 2018
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.

Table.  Weighted Number and Proportion of Adults 70 Years and Older Using Hearing Aids in the United States From 2011 to 2018a,b
Weighted Number and Proportion of Adults 70 Years and Older Using Hearing Aids in the United States From 2011 to 2018a,b
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.2010.362PubMedGoogle ScholarCrossref
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.2018.2875PubMedGoogle ScholarCrossref
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.2011.1408PubMedGoogle ScholarCrossref
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/gny051PubMedGoogle ScholarCrossref
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:10.1177/0898264315585505PubMedGoogle ScholarCrossref
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.2019.00451PubMedGoogle ScholarCrossref
Research Letter
December 7, 2020

Trends in Hearing Aid Ownership Among Older Adults in the United States From 2011 to 2018

Author Affiliations
  • 1Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
JAMA Intern Med. 2021;181(3):383-385. doi:10.1001/jamainternmed.2020.5682

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.

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.

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Article Information

Accepted for Publication: August 17, 2020.

Published Online: December 7, 2020. doi:10.1001/jamainternmed.2020.5682

Corresponding Author: Nicholas S. Reed, AuD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Ste 1-500, Baltimore, MD 21205 (nreed9@jhmi.edu).

Author Contributions: Drs Reed and Garcia Morales had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Reed, Willink.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Reed.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Reed, Garcia Morales.

Supervision: Willink.

Conflict of Interest Disclosures: Dr Reed reported grants from the National Institute on Aging, consulting fees from Helen of Troy, and being a scientific advisory board member of Shoebox Inc and Good Machine Studio. Dr Willink reported grants from the Commonwealth Fund and Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health during the conduct of the study, personal fees from BioMedical Insights, and speaker honoraria from the American Speech-Language-Hearing Association outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant K23AG065443 (Dr Reed) from the National Institutes of Health/National Institute on Aging.

Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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.2010.362PubMedGoogle ScholarCrossref
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.2018.2875PubMedGoogle ScholarCrossref
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.2011.1408PubMedGoogle ScholarCrossref
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/gny051PubMedGoogle ScholarCrossref
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:10.1177/0898264315585505PubMedGoogle ScholarCrossref
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.2019.00451PubMedGoogle ScholarCrossref
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