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Original Investigation
March 2017

Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years

Author Affiliations
  • 1Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
  • 2Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at San Antonio
  • 3Department of Otolaryngology–Head and Neck Surgery, The University of California at Davis
  • 4Dobie Associates, San Antonio, Texas
  • 5Hearing Loss Prevention Team, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
  • 6Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo
  • 7Stephenson & Stephenson Research & Consulting, Loveland, Ohio
JAMA Otolaryngol Head Neck Surg. 2017;143(3):274-285. doi:10.1001/jamaoto.2016.3527
Key Points

Question  What changes have occurred in the prevalence of age- and sex-specific hearing loss during the past decade for adults aged 20 to 69 years?

Findings  Using data from the National Health and Nutrition Examination Survey, this study found that while the prevalence of hearing loss has continued to decline among adults aged 20 to 69 years, adult hearing loss is associated with increasing age, sex, race/ethnicity, educational level, and noise exposure.

Meaning  These results are consistent with a delayed onset of hearing loss to older ages and increased hearing health care needs as the US population grows and ages.


Importance  As the US population ages, effective health care planning requires understanding the changes in prevalence of hearing loss.

Objective  To determine if age- and sex-specific prevalence of adult hearing loss has changed during the past decade.

Design, Setting, and Participants  We analyzed audiometric data from adults aged 20 to 69 years from the 2011-2012 cycle of the US National Health and Nutrition Examination Survey, a cross-sectional, nationally representative interview and examination survey of the civilian, noninstitutionalized population, and compared them with data from the 1999-2004 cycles. Logistic regression was used to examine unadjusted, age- and sex-adjusted, and multivariable-adjusted associations with demographic, noise exposure, and cardiovascular risk factors. Data analysis was performed from April 28 to June 3, 2016.

Interventions  Audiometry and questionnaires.

Main Outcomes and Measures  Speech-frequency hearing impairment (HI) defined by pure-tone average of thresholds at 4 frequencies (0.5, 1, 2, and 4 kHz) greater than 25 decibels hearing level (HL), and high-frequency HI defined by pure-tone average of thresholds at 3 frequencies (3, 4, and 6 kHz) greater than 25 decibels HL.

Results  Based on 3831 participants with complete threshold measurements (1953 men and 1878 women; mean [SD] age, 43.6 [14.4] years), the 2011-2012 nationally weighted adult prevalence of unilateral and bilateral speech-frequency HI was 14.1% (27.7 million) compared with 15.9% (28.0 million) for the 1999-2004 cycles; after adjustment for age and sex, the difference was significant (odds ratio [OR], 0.70; 95% CI, 0.56-0.86). Men had nearly twice the prevalence of speech-frequency HI (18.6% [17.8 million]) as women (9.6% [9.7 million]). For individuals aged 60 to 69 years, speech-frequency HI prevalence was 39.3% (95% CI, 30.7%-48.7%). In adjusted multivariable analyses for bilateral speech-frequency HI, age was the major risk factor (60-69 years: OR, 39.5; 95% CI, 10.5-149.4); however, male sex (OR, 1.8; 95% CI, 1.1-3.0), non-Hispanic white (OR, 2.3; 95% CI, 1.3-3.9) and non-Hispanic Asian race/ethnicity (OR, 2.1; 95% CI, 1.1-4.2), lower educational level (less than high school: OR, 4.2; 95% CI, 2.1-8.5), and heavy use of firearms (≥1000 rounds fired: OR, 1.8; 95% CI, 1.1-3.0) were also significant risk factors. Additional associations for high-frequency HI were Mexican-American (OR, 2.0; 95% CI, 1.3-3.1) and other Hispanic race/ethnicity (OR, 2.4; 95% CI, 1.4-4.0) and the combination of loud and very loud noise exposure occupationally and outside of work (OR, 2.4; 95% CI, 1.4-4.2).

Conclusions and Relevance  Adult hearing loss is common and associated with age, other demographic factors (sex, race/ethnicity, and educational level), and noise exposure. Age- and sex-specific prevalence of HI continues to decline. Despite the benefit of delayed onset of HI, hearing health care needs will increase as the US population grows and ages.