1,721,160 research outputs found
Turning up the volume on the issue of hearing health inequalities in England: an update on hearing loss prevalence estimates after four decades
No full textPrevalence statistics of hearing loss in adults: harnessing spatial big data to estimate patterns and trends
No full textBackground: Hearing loss is estimated to affect over eight million adults aged over 50 in England. These estimates are based on the prevalence data reported in the ‘Hearing in Adults’ study by Davis, who collected audiological data for 1,538 subjects 50 years old and above in the 1980s. The prevalence (%) per age group from this study’s samples is being applied to the most recent English census. We aimed to (a) explore regional patterns and trends of hearing loss in a representative longitudinal prospective cohort study of the English older population, and (b) identify potential regional differences with the current prevalence estimates.Methods: We utilised the full dataset (74,699 person-years) of the English Longitudinal Study of Ageing (ELSA). We used local spatial statistics to analyse spatial distributions, patterns and trends of the geographical data, examining both self-reported and objective hearing data. The objectively identified hearing loss was defined as greater than 35 dB HL at 3.0 kHz, in the better hearing ear, as measured by a handheld audiometric screening device (HearCheck Screener).Results: There was a wide variation in hearing loss prevalence in representative samples from different regions in England with similar age profiles (Fig 1.). In a period of 15 years (2002-2017) the increase rate of hearing loss ranged between regions from 3.2% to 45%. The Getis-Ord Gi* spatial statistic showed marked regional variability, and hearing health inequalities between Northern and Southern England that were previously unknown.Conclusion: The profound multidisciplinary professional and experimental care in the ‘Hearing in Adults’ study by Davis is broadly recognised; however, our study showed that this data does not remain valid and generalisable. The time of small-scale research should be consigned to the past; applying computational approaches in audiology might offer promising solutions to generate large-scale epidemiological inferences to improve population’s hearing health
Forty years on: a new national study of hearing in England and implications for global hearing health policy
No full textObjective: we aimed to update the prevalence estimates of hearing loss in older adults in England using a nationally representative sample of adults aged 50 years old and older.Design: a comparative cross-sectional study design was implemented. Hearing loss was defined as ≥35 dB HL at 3.0 kHz, as measured via Hearcheck in the better-hearing ear.Study sample: we compared the estimates based on the English census in 2015 to estimates from psychoacoustic hearing data available for 8,263 participants in the English Longitudinal Study of Ageing (ELSA) Wave 7 (2014–2015).Results: marked regional variability in hearing loss prevalence was revealed among participants with similar age profiles. The regional differences in hearing outcomes reached up to 13.53% in those belonging to the 71–80 years old group; the prevalence of hearing loss was 49.22% in the North East of England (95%CI 48.0–50.4), versus 35.69% in the South East (95%CI 34.8–36.50).Conclusion: a socio-spatial approach in planning sustainable models of hearing care based on the actual populations’ needs and not on age demographics might offer a viable opportunity for healthier lives. Regular assessment of the extent and causality of the population’s different audiological needs within the country is strongly supported
Socioeconomic and Lifestyle Factors Associated with Hearing Loss in Older Adults:A Cross-sectional Study of the English Longitudinal Study of Ageing (ELSA)
No full textOBJECTIVES:Aims were (1) to examine whether socioeconomic position (SEP) is associated with hearing loss (HL) among older adults in England and (2) whether major modifiable lifestyle factors (high body mass index, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) are associated with HL after controlling for non-modifiable demographic factors and SEP.SETTING:We used data from the wave 7 of the English Longitudinal Study of Ageing, which is a longitudinal household survey dataset of a representative sample of people aged 50 and older.PARTICIPANTS:The final analytical sample was 8529 participants aged 50-89 that gave consent to have their hearing acuity objectively measured by a screening audiometry device and did not have any ear infection.PRIMARY AND SECONDARY OUTCOME MEASURES:HL defined as >35 dBHL at 3.0 kHz (better-hearing ear). Those with HL were further subdivided into two categories depending on the number of tones heard at 3.0 kHz.RESULTS:HL was identified in 32.1% of men and 22.3% of women aged 50-89. Those in a lower SEP were up to two times more likely to have HL; the adjusted odds of HL were higher for those with no qualifications versus those with a degree/higher education (men: OR 1.87, 95%CI 1.47 to 2.38, women: OR 1.53, 95%CI 1.21 to 1.95), those in routine/manual occupations versus those in managerial/professional occupations (men: OR 1.92, 95%CI 1.43 to 2.63, women: OR 1.25, 95%CI 1.03 to 1.54), and those in the lowest versus the highest income and wealth quintiles (men: OR 1.62, 95%CI 1.08 to 2.44, women: OR 1.36, 95%CI 0.85 to 2.16, and men: OR1.72, 95%CI 1.26 to 2.35, women: OR 1.88, 95%CI 1.37 to 2.58, respectively). All regression models showed that socioeconomic and the modifiable lifestyle factors were strongly associated with HL after controlling for age and gender.CONCLUSIONS:Socioeconomic and lifestyle factors are associated with HL among older adults as strongly as core demographic risk factors, such as age and gender. Socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.</p
Mental Health Inequalities among Adults with Hearing Loss: Findings from the English Longitudinal Study of Ageing (ELSA)
Full text linkObjectives: To examine the relationship between mental health and hearing loss among older adults at various socioeconomic strata. Design: Retrospective cohort study from up to seven waves of data collection covering a period of fourteen years of the English Longitudinal Study of Ageing (ELSA), which is a unique and rich resource of information on the health, social, wellbeing and economic circumstances of the English population aged 50 and older. Methods: Hearing loss was defined as >35dB HL at 3.0 kHz (better-hearing ear). Cross-sectional associations between self-reported and objective (available only in wave 7) hearing measures and depression were examined using multinomial-logistic regression (n=8,529). The longitudinal association between self-reported hearing at Wave 1 (2002/03) and diagnosis of depression up to Wave 7 (2014/15) was modelled using Cox proportional hazards regression. Results: The prevalence of depression among adults with hearing loss increased with time in each net financial wealth quintile in waves 1 to 7. In men, the increase of depression was tripled from wave 1 to wave 7 in the lowest wealth group, whereas in men in the higher wealth groups and in women across all wealth groups, the prevalence approximately doubled. Conclusions: Hearing impairment increases the risk for depression at least twice in the full sample and three times in lower wealth groups. These findings are consistent with the hypothesis that early detection of hearing loss could help delay the onset of depression, or that hearing loss is likely to be driving people to depression, particularly in lower wealth groups
Under-diagnosis of Hearing Loss in Primary Care: Evidence from the English Longitudinal Study of Ageing (ELSA)
Full text linkBackground: Hearing loss is a major public health issue that affects one-in-six people and over 11 million people across the UK. Hearing loss is far beyond a sensory impairment, and is associated with negative physical, social, cognitive, economic and emotional consequences. Primary health care (PHC) is the point of referral to NHS audiological services for hearing loss in adults. However, as hearing loss almost always develops gradually, people do not see it as a dramatic health problem requiring urgent intervention. The aim of this study was to examine the patterns of the diagnosis of hearing loss in primary care. Method: Cross-sectional analysis comparing self-reported hearing data and data acquired by an objective assessment of hearing ability, from the Wave 7 of the English Longitudinal Study of Ageing (ELSA) (n=9,666). Hearing loss was defined as >35dB HL at 3.0 kHz, in the better-hearing ear. Questions were on hearing difficulties of the participants, hearing in noise, quality of care in hearing, and hearing aid recommendation (Figure 1). Results: The prevalence of the self-reported hearing difficulties in ELSA Wave 7 (n=9,666), was 39.3% (n=3,801/9,666). Of those, 51.3% (n=1,949/3,801) did not discuss their hearing problems with a primary care health professional, and were not referred to an ear specialist. An increase of approximately 23% in the number of hearing aid users is estimated among the participants with hearing loss, provided that those that have difficulty in following a conversation in background noise have told a health professional in primary care about their hearing difficulty. Implications: The self-identification of hearing difficulties is a major non-financial barrier for the initiation of help-seeking, which can affect the referral to ear specialists and the consequent hearing aid uptake. Our findings can offer an explanation why those of a lower socioeconomic position use specialist health services less frequently, in spite of the financial support of the treatment and hearing aid provision through the NHS in the UK. Our findings support the need for health policy strategies, aiming for an early detection of hearing problems and an increase in hearing aid uptake and use in specific population groups, to mitigate the adverse effects of hearing loss in older adults in England
“Lifestyle-Related Hearing Loss”: a New Approach to a Major Public Health Challenge, Using Evidence from the English Longitudinal Study of Ageing (ELSA)
No full textTheory/framework: HL is a major public health challenge and its prevention requires understanding of its determinants.Methods and hypotheses: Multiple logistic regression modelling (n=8,529, aged 50-89), examining the association of HL with non-modifiable (age, gender), partly modifiable (socioeconomic indicators), and fully modifiable lifestyle risk factors (body mass index, physical activity, smoking and alcohol consumption). Results: Socioeconomic and lifestyle risk factors were largely associated with HL, while age was not the most important risk factor.Conclusion: HL may be a potential preventable lifestyle disease and not necessarily an inevitable accompaniment of ageing, paving the way for interventions to improve population’s health.<br/
The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids:answers from the English Longitudinal Study of Ageing (ELSA)
Full text linkPURPOSE: The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive symptoms over time.METHODS: We examined the longitudinal relationship between HL and depressive symptoms (CES-D) applying dynamic cross-lagged mediation path models. We used the full dataset of participants aged 50-89 years (74,908 person-years), from all eight Waves of the English Longitudinal Study of Ageing (ELSA). Their quality of life (CASP-19) and their wealth were examined as the mediator and moderator of this relationship, respectively. Subgroup analyses investigated differences among those with hearing aids within different models of subjectively and objectively identified HL. All models were adjusted for age, sex, retirement status and social engagement.RESULTS: Socioeconomic position (SEP) influenced the strength of the relationship between HL and depression, which was stronger in the lowest versus the highest wealth quintiles. The use of hearing aids was beneficial for alleviating depressive symptoms. Those in the lowest wealth quintiles experienced a lower risk for depression after the use of hearing aids compared to those in the highest wealth quintiles.CONCLUSION: HL poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities. The early detection of HL and provision of hearing aids may not only promote better-hearing health but could also enhance the psychosocial wellbeing of older adults, particularly those in a lower SEP.</p
Regional patterns and trends of hearing loss in England: evidence from the English longitudinal study of ageing (ELSA) and implications for health policy
No full textBackground: hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over.Methods: we used the full dataset (74,699 person-years) of self-reported hearing data from all eight Waves of the English Longitudinal Study of Ageing (ELSA) (2002–2017). We examined the geographical identifiers of the participants at the Government Office Region (GOR) level and the geographically based Index of Multiple Deprivation (IMD). The primary outcome measure was self-reported HL; it consisted of a merged category of people who rated their hearing as fair or poor on a five-point Likert scale (excellent, very good, good, fair or poor) or responded positively when asked whether they find it difficult to follow a conversation if there is background noise (e.g. noise from a TV, a radio or children playing).Results: a marked elevation in HL prevalence (10.2%) independent of the age of the participants was observed in England in 2002–2017. The mean HL prevalence increased from 38.50 (95%CI 37.37–39.14) in Wave 1 to 48.66 (95%CI 47.11–49.54) in Wave 8. We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants in the most deprived (IMD) quintile, in routine or manual occupations and misusing alcohol. The adjusted HL predictions at the means (APMs) showed marked regional variability and hearing health inequalities between Northern and Southern England that were previously unknown.Conclusions: a sociospatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities. The Clinical Commissioning Groups (CCGs) currently responsible for the NHS audiology services in England should not consider HL an inevitable accompaniment of older age; instead, they should incorporate socio-economic factors and modifiable lifestyle behaviours for HL within their spatial patterning in England
Conceptual model of hearing health inequalities (HHI model): a critical interpretive synthesis
No full textHearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and preventthe adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging
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