Hearing loss (HL) is highly prevalent with age, and historical rates of hearing aid (HA) uptake among adults have generally been low, with less than 20% of adults with HL reporting HA use.1 Whether rates of uptake have changed over the past decade has not been well characterized. Understanding the prevalence of HA use is important to evaluate the effect of both recently passed legislation permitting over-the-counter hearing aids2 and currently active legislation related to Medicare hearing coverage. We investigated if the prevalence of HA use differed among mid- to late-life older adults aged 50 to 69 years in 2011 to 2016 vs 1999 to 2004 in the US.
We used data from the National Health and Nutritional Examination Surveys (NHANES), a nationally representative examination survey of the civilian, noninstitutionalized US population, from distinct temporal periods: 1999 to 2004 (merged data from the 1999-2000, 2001-2002, and 2003-2004 NHANES cycles) and 2011 to 2016 (merged data from the 2011-2012 and 2015-2016 cycles [audiometric data were not gathered in 2013-2014]). Our analytic cohort comprised adults aged 50 to 69 years in each time period with available audiometric and covariate data.
Overall, HA use was measured by the question, “over the last 12 months how often did you wear your hearing aids?” Hearing aid use response categories differed across the temporal periods and was defined as “at least once a day” or more in 1999 to 2004 and “about half the time” or more in 2011 to 2016 to reflect clinically meaningful utilization.3 Given the changing response categories, we conducted sensitivity analyses with less stringent definitions of HA in 1999 to 2004 (eTables 1 and 2 in the Supplement).
Audiometry was conducted using established NHANES protocols in sound-attenuating booths. Hearing was defined by the speech-frequency (0.5, 1, 2, 4 kHz) pure-tone average in the better-hearing ear and categorized per the World Health Organization (mild [25-39dB HL], moderate [40-59dB], severe [60+dB]).
The proportion and population weighted estimates of HL and HA use stratified by severity of HL by time period were compared using odds ratios. Multivariable-adjusted logistic regression was then used to assess the odds of HA use by time period controlling for age, sex, education, race, and hearing in our adjusted models. Stata statistical software (version 16, StataCorp) was used for data analysis. To account for the complex sampling design of NHANES, our analysis (per National Center for Health Statistics guidelines) incorporated recommended sample weights to adjust for oversampling of selected populations. This research was considered nonhuman subjects research by Johns Hopkins University and was deemed exempt from institutional review board review.
Among adults aged 50 to 69 years in 2011 to 2016 vs 1999 to 2004, the overall prevalence of any HL decreased by 4.4% (95% CI, 0.6%-8.2%), whereas rates of HA use increased by 7.5% (95% CI, 1.1%-13.8%). The multivariable adjusted odds of HA use was 2.85-fold (95% CI, 1.49-5.44) greater in in 2011 to 2016 compared with 1999 to 2004. Results were consistent across alternate definitions of HA use (Table).
In a nationally representative study, adults aged 50 to 69 years were less likely to have audiometric HL and more likely to report HA use in 2011 to 2016 than in 1999 to 2004. The lower prevalence of HL across temporal periods was consistent with other studies, and recent analyses of Medicare data reported a similar trend in increasing HA ownership in adults older than 70 years.4,5 The basis of the higher prevalence of HA use is unknown but may be related to emerging awareness of the health effects of HL or generational differences that may affect willingness to adopt hearing technologies.6 For example, increasing levels of educational attainment are observed between the 2 generational cohorts, which is associated with HA use but may not be fully controlled for in these analyses.
A sensitivity analysis using a less stringent definition of HA use in 1999 to 2004 yielded similar results, but cautious interpretation of the observed increase in HA use over time is warranted given the slightly different response scales for HA use between the 2 time periods in NHANES.
Although temporal trends of lower prevalence of HL and higher HA uptake over time are encouraging, future policy and intervention efforts are needed to address the large number of adults with untreated HL. Recently passed legislation permitting over-the-counter HAs and ongoing Medicare legislation may help improve access to and affordability of hearing care.
Accepted for Publication: June 1, 2021.
Published Online: July 29, 2021. doi:10.1001/jamaoto.2021.1572
Corresponding Author: Frank R. Lin, MD, PhD, Johns Hopkins Outpatient Center, 601 N Caroline St, 6th Flr, Baltimore, MD 21287 (Flin1@jhmi.edu).
Author Contributions: Dr Wu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Wu, Reed, Lin.
Acquisition, analysis, or interpretation of data: Wu, Thallmayer, Deal.
Drafting of the manuscript: Wu, Thallmayer.
Critical revision of the manuscript for important intellectual content: Wu, Deal, Reed, Lin.
Statistical analysis: Wu.
Administrative, technical, or material support: Thallmayer, Lin.
Conflict of Interest Disclosures: Dr Lin is a consultant to Frequency Therapeutics, speaker honoraria from Caption Call, and director of a public health research center funded in part by a philanthropic gift from Cochlear Ltd to the Johns Hopkins Bloomberg School of Public Health. Dr Reed is a scientific advisor (nonfinancial) to Shoebox, Inc. No other disclosures were reported.
National Academies of Sciences, Engineering, Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016.
US Congress. HR 2430: FDA Reauthorization Act of 2017. In: August; 2017.
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