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    Original Investigation
    Public Health
    August 27, 2020

    Comparison of Self-reported Measures of Hearing With an Objective Audiometric Measure in Adults in the English Longitudinal Study of Ageing

    Author Affiliations
    • 1Institute for Health Policy and Organisation, Centre for Primary Care and Health Services Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
    • 2Institute for Health Policy and Organisation, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
    • 3National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
    JAMA Netw Open. 2020;3(8):e2015009. doi:10.1001/jamanetworkopen.2020.15009
    Key Points español 中文 (chinese)

    Questions  Among middled-aged adults, are self-reported measures of hearing concordant with audiometry findings, and is potential discordance associated with age or lifestyle factors?

    Findings  In this cross-sectional study of 9666 participants in the English Longitudinal Study of Ageing, self-report measures of hearing had limited accuracy and were not sufficiently sensitive to detect hearing loss. Hearing loss went undetected by the self-reported measures.

    Meaning  These findings may inform public health policies relevant to selection of appropriate and validated tools for detecting hearing problems among middle-aged and older adults.


    Importance  An effective and sustainable hearing loss (HL) screening strategy for the early detection of and intervention for HL in older adults is needed.

    Objectives  To examine the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures across different population subgroups of a representative sample of people 50 years and older in England.

    Design, Setting, and Participants  This study was a cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA), a large, population-based, prospective cohort study that provides a unique resource for exploring issues associated with aging in England in the 21st century. The full analytic cohort was composed of 9666 individuals participating in the ELSA wave 7, which collected information from June 1, 2014, to May 31, 2015. This study further analyzed a sample of 8529 adults 50 to 89 years of age who had an assessment of their hearing by self-reported measures, and consented to assessment by a qualified nurse via a hearing screening device, and did not have an ear infection or a cochlear implant. Bivariate analyses were performed from July 1 to December 30, 2018, and multivariate analysis from January 1 to June 30, 2019. Multiple logistic regression models examined factors associated with misclassification of hearing difficulties across several categories among those with objectively identified HL.

    Exposures  The study examined whether age, marital status, retirement status, indicators of socioeconomic position, and lifestyle factors (such as body mass index, physical activity, and tobacco and alcohol consumption) were associated with the concordance between self-reported hearing problems and manual audiometry among older adults.

    Main Outcomes and Measures  Self-reported hearing measures, including hearing in background noise, compared with objective audiometric assessments.

    Results  A total of 9666 study participants (5368 female [55.5%]; mean [SD] age, 67.4 [14.4] years) provided responses regarding their hearing difficulties, hearing in noise, quality of care in hearing, and hearing aid recommendation in ELSA wave 7. Within the cohort, 684 individuals (30.2%) with objectively measured HL greater than 35 dB HL at 3.0 kHz went undetected by the self-report measure, whereas the new constructed categories for moderate and moderately severe or severe HL resulted in 9.3% increased sensitivity. Factors associated with misreporting hearing difficulties (while they had objectively measured HL >35 dB HL at 3.0 kHz, in the better-hearing ear) were as follows: female sex (odds ratio [OR], 1.97; 95% CI, 1.18-3.28), no educational qualifications (OR, 1.37; 95% CI, 1.26-2.55), routine or manual occupation (OR, 1.43; 95% CI, 1.28-2.61), tobacco consumption (OR, 1.14; 95% CI, 1.08-1.90), alcohol intake above the low-risk-level guidelines (OR, 1.13; 95% CI, 1.11-2.34), and lack of moderate physical activity (OR, 1.25; 95% CI, 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95% CI, 1.17-8.13) higher for those 65 to 74 years of age and 7.08 (95% CI, 1.41-9.30) higher for those 75 to 89 years of age to not report their hearing difficulties compared with those 50 to 64 years of age. In addition, socioeconomic indicators, such as educational level (OR, 1.95; 95% CI, 1.63-6.01) and occupation (OR, 2.07; 95% CI, 1.78-5.40), along with lifestyle factors, such as smoking (OR, 1.46; 95% CI, 1.25-2.48) and alcohol intake above the low-risk-level guidelines (OR, 1.86; 95% CI, 1.67-5.12), were factors associated with misreporting moderately severe or severe HL.

    Conclusions and Relevance  The use of a screening measure for audiometric testing and a self-report measure is essential for accurately identifying older people with HL. The results of this study should be considered by HL researchers who analyze self-reported hearing data as a surrogate measurement of audiometric hearing to identify bias in their observed analytic research results.