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Original Investigation
October 8, 2020

Dual Sensory Impairment and Perceived Everyday Discrimination in the United States

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 2Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
  • 3Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Ophthalmol. Published online October 8, 2020. doi:10.1001/jamaophthalmol.2020.3982
Key Points

Question  How is sensory impairment associated with increased discrimination among older adults?

Findings  In a US population-based survey, older adults reporting vison or hearing loss perceived greater discrimination than older adults not reporting these impairments, and older adults with dual sensory impairment (concurrent vison and hearing loss) perceived the greatest levels of discrimination.

Meaning  These results suggest that older adults with sensory impairments perceive greater levels of discrimination than older adults without these impairments.


Importance  Perceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality.

Objective  To assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination.

Design, Setting, and Participants  Cross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019.

Exposures  Participants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI.

Main Outcomes and Measures  Perceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis).

Results  The sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (β [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (β = 0.07; 95% CI, 0.02-0.11), and DSI (β = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone.

Conclusions and Relevance  Older adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.

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