Background: The mechanisms linking lifestyle to hearing impairment remain unclear. This study seeks to examine the associations of lifestyle factors with hearing impairment and to quantify the mediating effects of inflammatory and metabolic biomarkers in these associations.Methods: In 441,844 UK Biobank participants, lifestyle was scored across seven behaviors. Biomarkers included an inflammatory score, metabolic score for insulin resistance (METS-IR) and their individual components. Cox proportional hazards regression was used to examine the independent associations of lifestyle and biomarkers with hearing impairment. Mediation analysis was then performed to evaluate the mediating role of these biomarkers.Results: Over a median follow-up of 14.22 years, 20,743 incident hearing impairment cases were documented. Adherence to an ideal lifestyle was associated with a 14% lower risk (HR = 0.86, 95% CI: 0.82–0.90) compared with a poor lifestyle, while elevated inflammatory score (HR = 1.03, 95% CI: 1.02–1.04) and metabolic score for insulin resistance (HR = 1.08, 95% CI: 1.06–1.10) significantly increased risk. Mediation analyses showed that inflammatory and metabolic biomarkers collectively explained 1%–20% of the lifestyle-hearing impairment association, with metabolic factors (body mass index, high-density lipoprotein cholesterol) contributing most substantially.Conclusion: Adherence to a healthy lifestyle was associated with lower hearing impairment risk, with inflammation and metabolic dysregulation acting as partial mediators. This offers mechanistic insights and supports lifestyle-based interventions for hearing impairment prevention.
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