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Original Investigation
November 8, 2018

Incident Hearing Loss and ComorbidityA Longitudinal Administrative Claims Study

Author Affiliations
  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 3Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 4OptumLabs, Cambridge, Massachusetts
  • 5Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, Chicago
  • 6AARP Services, Inc, Washington, DC
JAMA Otolaryngol Head Neck Surg. Published online November 8, 2018. doi:10.1001/jamaoto.2018.2876
Key Points

Question  What is the association between incident hearing loss diagnosis and medical comorbidities in US adults 50 years or older?

Findings  In this retrospective, propensity-matched cohort study using administrative claims data, hearing loss was significantly associated with an increased 10-year risk of dementia (3.2 per 100 persons), depression (3.6 per 100 persons), falls (6.9 per 100 persons), and myocardial infarction (1.1 per 100 persons).

Meaning  Incident hearing loss is independently related to the risk of other medical diagnoses; mechanisms underlying these associations should be elucidated to determine if hearing loss treatment can reduce risk and maintain health in adults with hearing loss.

Abstract

Importance  Because hearing loss is highly prevalent and treatable, determining its association with morbidity has major public health implications for disease prevention and the maintenance of health in adults with hearing loss.

Objective  To investigate the association between the diagnosis of incident hearing loss and medical comorbidities in adults 50 years or older.

Design, Setting, and Participants  Retrospective, propensity-matched cohort study using administrative claims data from commercially insured and Medicare Advantage members in a geographically diverse US health plan. Adults 50 years or older with claims for services rendered from January 1, 2000, to December 31, 2016, were observed for 2 (n = 154 414), 5 (n = 44 852), and 10 (n = 4728) years. This research was conceptualized and data were analyzed between September 2016 and November 2017.

Exposures  A claim for incident hearing loss is defined as 2 claims for hearing loss within 2 consecutive years without evidence of hearing device use, excluding claims for sudden hearing loss or hearing loss secondary to medical conditions.

Main Outcomes and Measures  Incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke.

Results  After cohort matching, 48% of participants were women (n = 74 464), 61% were white (n = 93 442), and 31% (n = 48 056) were Medicare Advantage insured, with a mean (SD) age of 64 (10) years. In a multivariate-adjusted modified Poisson regression with robust standard errors, relative associations were strongest for dementia (relative risk at 5 years, 1.50; 95% CI, 1.38-1.64) and depression (relative risk at 5 years, 1.41; 95% CI, 1.26-1.58). The absolute risk of all outcomes was greater in persons with hearing loss than in those without hearing loss at all times, with the greatest risk difference observed at 10 years for all outcomes. The 10-year risk attributable to hearing loss was 3.20 per 100 persons (95% CI, 1.76-4.63) for dementia, 3.57 per 100 persons (95% CI, 1.67-5.47) for falls, and 6.88 per 100 persons (95% CI, 4.62-9.14) for depression.

Conclusions and Relevance  In this large observational study using administrative claims data, incident untreated hearing loss was associated with greater incident morbidity than no hearing loss across a range of health conditions. Future studies are needed to elucidate the mechanisms underlying these associations and to determine if treatment for hearing loss could reduce the risk of comorbidity.

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