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Original Investigation
January 2019

Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 2OptumLabs, Cambridge, Massachusetts
  • 3Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
  • 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 5AARP Services, Inc, Washington, DC
  • 6University of California San Francisco School of Nursing, San Francisco
JAMA Otolaryngol Head Neck Surg. 2019;145(1):27-34. doi:10.1001/jamaoto.2018.2875
Key Points

Question  Is untreated hearing loss associated with higher health care costs and utilization?

Findings  In this retrospective, propensity-matched cohort study of claims data, compared with no hearing loss, untreated hearing loss was associated with higher health care costs and a higher risk of 30-day hospital readmission over a 10-year period.

Meaning  Untreated hearing loss may contribute to greater health care costs and utilization.


Importance  Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.

Objective  To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.

Design, Setting, and Participants  Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.

Exposures  Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.

Main Outcomes and Measures  Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.

Results  Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.

Conclusions and Relevance  Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.