Danielle M. Foley|Kevin D. Frick|Frank R. Lin
Association Between Hearing Loss and Healthcare Expenditures in Older Adults
Lewin Group (United States)|Johns Hopkins University|Johns Hopkins University
hearing loss hl chronic condition affects nearly twothirds older adults united states1 independently associated cognitive decline2 excess hospitalizations3 depression4 poor quality life5 whether hearing loss also independently associated higher medical care expenditures unclear economic burden hl estimated nationally representative sample adults aged 65 older pooled data study derived years 2000 2010 medical expenditure panel survey household component nationally representative overlapping panel survey us civilian noninstitutionalized population6 detailed data demographic characteristics health conditions medical expenditures collected computerassisted personal interviews healthrelated quality life hrqol measured using medical outcomes study 12item shortform survey version 2 hl based selfreport summarized binary variable vs hearing loss excluding deafness individuals classified hl reported difficulty hearing hear things people say difficulty hearing cannot hear things people say hear difficulty hearing cannot hear things people say cannot hear things people say deaf monetary outcomes measured total healthcare expenditures components care adjusted 2012 us dollars disregarding payment source nonmonetary outcomes included total informal care days provided unpaid independent caregivers hrqol scores following agency healthcare research quality algorithm response coding6 demographic health factors could potentially confound association selfreported hearing loss expenditures adjusted probability positive expenditures informal care days analyzed using logistic regression excess expenditures estimated generalized linear model log link gamma poisson family hrqol scores mapped continuous outcome allow linear regression analyses accounted complex sampling design missing values due nonresponses refusals survey skip pattern excluded analyses performed using stata 120 statacorp college station tx analytical sample 34981 individuals 2000 2010 medical expenditure panel survey aged 65 older 237 individuals selfreported hl individuals selfreported hl significantly likely older male lower socioeconomic status cardiovascular conditions diabetes mellitus also likely selfreport poor overall health status 79 without hl reporting excellent good health compared 71 hl p 001 fully adjusted model individuals hl significantly greater odds nonzero total medical expenditures odds ratio 139 95 confidence interval ci 112171 average 392 excess medical expenditures 95 ci 277513 table 1 within individual components care respondents hl significantly greater odds nonzero expenditures officebased outpatient emergency department visits physical mental health summary scores averaged 17 points lower 95 ci 135199 09 points lower 95 ci 061123 scores individuals hl respectively results demonstrate selfreported hl independently associated higher total medical expenditures applying results population individuals selfreported hl us population aged 65 older 2010 791 million indicates hl associated approximately 310 billion excess total medical expenditures united states hl associated greater odds officebased outpatient emergency department visits costs would directly attributable hl treatment eg medical equipment expense potential mechanisms explain findings include association hearing loss healthrelated oral literacy falls cognitive decline depression social isolation alternatively common pathological cause eg chronic ear disease residual confounding unmeasured factors could underlie observed associations limitation study use selfreported rather objectively measured hearing status although potential limitation may underestimate excess medical expenditures associated hl many individuals significant audiometric hl often selfreport hl7 future work investigate mechanistic basis observed association whether public health strategies focused hearing rehabilitative treatment could mitigate excess medical expenditures associated hl conflict interest study supported grants national institute deafness communication disorders k23dc011279 triological society american college surgeons clinician scientist award eleanor schwartz charitable foundation danielle foley works lewin group healthcare consulting firm firm role development sponsorship article frank lin serves consultant cochlear americas scientific advisory board pfizer autifony speaker med el amplifon author contributions ms foley dr lin full access data study take responsibility integrity data accuracy data analysis study concept design frick lin acquisition data foley statistical analysis foley lin analysis interpretation data foley frick lin drafting manuscript foley frick lin sponsors role sponsors role design conduct study collection analysis interpretation data preparation review approval manuscript