Modifiable Risk Factors and Hearing Loss: The National Health and Nutrition Examination Survey 1999–2020

Objective To explore the associations between major modifiable risk factors and hearing loss. Methods This serial cross‐sectional study was conducted within the National Health and Nutrition Examination Survey 1999–2020 in the United States. Associations were assessed using modified Poisson regression and within‐sample population attributable fraction (PAF). Results Eight thousand seven hundred and seventy adults aged 40–85 years were included in the analyses, the mean (SD) age was 58.0 (11.7) years, with 4002 men (45.6%). Hearing loss was associated with low educational attainment with prevalence ratio 1.23, 95% confidence interval (1.15, 1.31); low income 1.11 (1.04, 1.19); diabetes 1.10 (1.03, 1.18); HDL‐C dyslipidaemia 1.13 (1.06, 1.21); obesity 1.08 (1.01, 1.15) and tobacco use 1.11 (1.04, 1.19). Within our analysis, over 25% of hearing loss cases were attributed to modifiable risk factors, with low education or income, HDL‐C dyslipidaemia, obesity and tobacco use being the leading contributors, though relative rankings varied slightly in survey‐weighted analyses. Conclusion Hearing promotion policies should prioritise related modifiable factors to reduce the burden of hearing loss.