Hearing Loss Among Older Adults With Heart Failure in the United States: Data From the National Health and Nutrition Examination Survey | Geriatrics | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Table 1.  Characteristics of the Study Population by Self-reported Heart Failure Status From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Surveya
Characteristics of the Study Population by Self-reported Heart Failure Status From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Surveya
Table 2.  Association Between Heart Failure and Hearing Loss Among Older Adults From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Survey
Association Between Heart Failure and Hearing Loss Among Older Adults From the 2005 to 2006 and 2009 to 2010 National Health and Nutrition Examination Survey
1.
Lin  FR, Thorpe  R, Gordon-Salant  S, Ferrucci  L.  Hearing loss prevalence and risk factors among older adults in the United States.  J Gerontol A Biol Sci Med Sci. 2011;66(5):582-590.PubMedGoogle ScholarCrossref
2.
Agrawal  Y, Platz  EA, Niparko  JK.  Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.  Otol Neurotol. 2009;30(2):139-145.PubMedGoogle ScholarCrossref
3.
Riegel  B, Moser  DK, Anker  SD,  et al; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research.  State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association.  Circulation. 2009;120(12):1141-1163.PubMedGoogle ScholarCrossref
4.
Centers for Disease Control and Prevention. The National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/index.htm. Accessed January 15, 2017.
5.
United States Census Bureau. Current Population Survey. https://www.census.gov/population/projections/data/national/2014.html. Accessed March 14, 2017.
6.
Johnson  CE, Danhauer  JL, Ellis  BB, Jilla  AM.  Hearing aid benefit in patients with mild sensorineural hearing loss: a systematic review.  J Am Acad Audiol. 2016;27(4):293-310.PubMedGoogle ScholarCrossref
Research Letter
March 2018

Hearing Loss Among Older Adults With Heart Failure in the United States: Data From the National Health and Nutrition Examination Survey

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
  • 2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3The Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 4Departments of Epidemiology, Geriatric Medicine, and Mental Health, Johns Hopkins University, Baltimore, Maryland
  • 5Department of Community Health and Social Sciences, City University of New York, Graduate School of Public Health and Health Policy, New York
JAMA Otolaryngol Head Neck Surg. 2018;144(3):273-275. doi:10.1001/jamaoto.2017.2979

Hearing loss is common among older adults in the United States1 and is associated with coronary heart disease and its risk factors.2 Yet, the prevalence of hearing loss among adults with heart failure (HF) has not been well described.

Heart failure is a chronic, incurable disease and is the leading cause of hospitalization among older adults in the United States. To mitigate disease progression, patients are asked to take multiple medications and make lifestyle changes.3 Given the high degree of self-care that HF imposes, it is imperative that patients can hear physician recommendations. Herein, we examined the prevalence and correlates of hearing loss among older adults with and without HF in the United States.

Methods

We analyzed data from adults 70 years and older from the 2005 to 2006 and 2009 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a series of ongoing cross-sectional surveys of the civilian noninstitutionalized US population.4 Participants had HF if they answered yes to, “Has a doctor ever diagnosed you with heart failure?” The World Health Organization criteria were used to classify the severity of hearing loss based on the pure-tone average (0.5-4.0 kHz) in the better ear. No hearing loss was 25 dB or less; mild, more than 25 but 40 dB or less; moderate, more than 40 but 60 dB or less; severe, more than 60 but 80 dB or less; and profound, more than 80 dB. Population projections were used to estimate the number of older adults with HF and hearing loss.5 Multivariable logistic regression was used to estimate the association between HF and hearing loss. The study was approved by the National Center for Health Statistics institutional review board, and NHANES obtained written informed consent from all participants.

Results

Participants with HF were older, had more cardiovascular comorbidities, and had a higher burden of hearing loss compared with those without HF (Table 1). Overall, the prevalence of hearing loss among participants with HF was 74.4% and the prevalence of hearing loss among those without HF was 63.3% (difference, 11.1%; 95 CI%, 1.0%-20.8%). Extrapolating these estimates to the US population, 1.7 million older adults with HF currently have hearing loss and by 2020, 2.4 million will.

The association between HF and hearing loss was also examined (Table 2). Participants with HF had 1.67 higher odds of mild or greater hearing loss (odds ratio [OR], 1.67; 95% CI, 1.02-2.72) compared with those without HF. Although the point estimate and upper bound of the confidence interval remained similar, this association was not significant in a fully adjusted model (adjusted OR [aOR], 1.65; 95% CI, 0.87-3.17). In this model, being 80 years or older (aOR, 4.65; 95% CI, 3.59-5.99), having less education (aOR, 1.9; 95% CI, 1.45-2.48), and greater noise exposure (aOR, 1.45; 95% CI, 1.01-2.07) were independently associated with mild or greater hearing loss.

Discussion

Overall, 75% of adults 70 years or older with HF have hearing loss. Although hearing loss was more common among adults with HF compared with those without it, HF was not independently associated with hearing loss after accounting for demographic and clinical characteristics. Future studies might examine potential correlates of hearing loss that we were unable to study, including ejection fraction and HF-specific medications like furosemide, which has ototoxic properties.

Notably, only 16.3% of participants with HF and hearing loss wore hearing aids, with the majority having moderate or greater hearing loss. Research suggests, however, that mild hearing loss also benefits from hearing aids.6 Since patients with HF are frequently in noisy hospitals and clinics where they receive myriad instructions about disease management, it seems likely that untreated hearing loss could impair patient-physician communication and ultimately HF self-care. Our findings suggest that audiometric screening and treatment of hearing loss among older adults with HF is warranted, in addition to improved communication techniques for physicians.

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Article Information

Corresponding Author: Madeline R. Sterling, MD, MPH, Department of Medicine, Weill Cornell Medical College, 1300 York Ave, PO Box 46, New York, NY 10065 (mrs9012@med.cornell.edu).

Accepted for Publication: November 12, 2017.

Published Online: January 25, 2018. doi:10.1001/jamaoto.2017.2979

Author Contributions: Dr Sterling and Dr Jannat-Khah had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Sterling, Lin, Safford.

Acquisition, analysis, or interpretation of data: Sterling, Lin, Jannat-Khah, Goman, Echeverria, Safford.

Drafting of the manuscript: Sterling.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sterling, Jannat-Khah.

Obtained funding: Sterling, Lin, Safford.

Administrative, technical, or material support: Safford.

Study supervision: Lin, Safford.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Goman and Lin are consultants for Cochlear Ltd. Dr Lin is a consultant for the Gerson Lehrman Group, has served on the scientific advisory boards of Pfizer and Autifony, has served as a speaker for Amplifon and has received a research grant from Cochlear Ltd. No other conflicts are reported.

Funding/Support: Dr Sterling is supported by the Agency for Healthcare Research and Quality (grant No. T32HS000066); Dr Lin is supported by the National Institutes of Health (grants K23DC01179, R34AG046548, R01HL096812 and R21DC015062) and the Eleanor Schwartz Charitable Foundation; and Dr Safford is supported by the National Institutes of Health (grant No. K24HL111154).

Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

References
1.
Lin  FR, Thorpe  R, Gordon-Salant  S, Ferrucci  L.  Hearing loss prevalence and risk factors among older adults in the United States.  J Gerontol A Biol Sci Med Sci. 2011;66(5):582-590.PubMedGoogle ScholarCrossref
2.
Agrawal  Y, Platz  EA, Niparko  JK.  Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.  Otol Neurotol. 2009;30(2):139-145.PubMedGoogle ScholarCrossref
3.
Riegel  B, Moser  DK, Anker  SD,  et al; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research.  State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association.  Circulation. 2009;120(12):1141-1163.PubMedGoogle ScholarCrossref
4.
Centers for Disease Control and Prevention. The National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/index.htm. Accessed January 15, 2017.
5.
United States Census Bureau. Current Population Survey. https://www.census.gov/population/projections/data/national/2014.html. Accessed March 14, 2017.
6.
Johnson  CE, Danhauer  JL, Ellis  BB, Jilla  AM.  Hearing aid benefit in patients with mild sensorineural hearing loss: a systematic review.  J Am Acad Audiol. 2016;27(4):293-310.PubMedGoogle ScholarCrossref
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