Association Between Hearing Loss and Healthcare Expenditures in Older Adults

This is the authors' abstract. We don't add key points for this paper.

Hearing loss (HL), a chronic condition that affects nearly two-thirds of older adults in the United States,1 has been independently associated with cognitive decline,2 excess hospitalizations,3 depression,4 and poor quality of life.5 Whether hearing loss is also independently associated with higher medical care expenditures is unclear. The economic burden of HL was estimated in a nationally representative sample of adults aged 65 and older. Pooled data for this study were derived from years 2000 to 2010 of the Medical Expenditure Panel Survey Household Component, a nationally representative overlapping panel survey of the U.S. civilian noninstitutionalized population.6 Detailed data on demographic characteristics, health conditions, and medical expenditures were collected through computer-assisted personal interviews. Health-related quality of life (HRQOL) was measured using the Medical Outcomes Study 12-item Short-Form Survey version 2. HL was based on self-report and summarized as a binary variable (no vs any hearing loss (excluding deafness)). Individuals were classified as having HL if they reported “Some difficulty hearing, can hear most things people say”; “Some difficulty hearing, cannot hear most things people say, can hear some”; or “Some difficulty hearing, cannot hear most things people say, cannot hear some things people say but not deaf.” Monetary outcomes were measured as total healthcare expenditures and components of care adjusted to 2012 U.S. dollars, disregarding payment source. Nonmonetary outcomes included total informal care days provided by unpaid, independent caregivers and HRQOL scores following the Agency for Healthcare Research and Quality algorithm of response coding.6 Demographic and health factors that could potentially confound the association of self-reported hearing loss and expenditures were adjusted for. The probability of any positive expenditures (informal care days) was analyzed using logistic regression. Excess expenditures were estimated from a generalized linear model with log link and gamma (Poisson) family. HRQOL scores were mapped as a continuous outcome to allow for linear regression. Analyses accounted for the complex sampling design. Missing values due to nonresponses, refusals, and the survey skip pattern were excluded. All analyses were performed using Stata 12.0 (StataCorp, College Station, TX). In an analytical sample of 34,981 individuals in the 2000 to 2010 Medical Expenditure Panel Survey aged 65 and older, 23.7% of individuals self-reported having HL. Individuals with self-reported HL were significantly more likely to be older, male, and of lower socioeconomic status and to have cardiovascular conditions and diabetes mellitus. They were also more likely to self-report poor overall health status, with 79% of those without HL reporting excellent or good health, compared with 71% of those with some HL (P < .001). In a fully adjusted model, individuals with HL had significantly greater odds of having nonzero total medical expenditures (odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.12–1.71) and, on average, had $392 in excess medical expenditures (95% CI = $277–513) (Table 1). Within individual components of care, respondents with HL had significantly greater odds of nonzero expenditures on office-based, outpatient, and emergency department visits, and their physical and mental health summary scores averaged 1.7 points lower (95% CI = 1.35–1.99) and 0.9 points lower (95% CI = 0.61–1.23) than scores of individuals with no HL, respectively. These results demonstrate that self-reported HL is independently associated with higher total medical expenditures. Applying these results to the population of individuals with self-reported HL in the U.S. population aged 65 and older in 2010 (7.91 million) indicates that HL is associated with approximately $3.10 billion in excess total medical expenditures in the United States. HL was associated with greater odds of office-based, outpatient, and emergency department visits and not only costs that would be directly attributable to HL treatment (e.g., medical equipment expense). Potential mechanisms to explain these findings include the association between hearing loss and health-related oral literacy, falls, cognitive decline, depression, and social isolation. Alternatively, a common pathological cause (e.g., chronic ear disease) or residual confounding by unmeasured factors could underlie the observed associations. A limitation of this study is the use of self-reported, rather than objectively measured, hearing status, although this potential limitation may underestimate excess medical expenditures associated with HL because many individuals with significant audiometric HL often do not self-report HL.7 Future work should investigate the mechanistic basis of the observed association and whether public health strategies focused on hearing rehabilitative treatment could mitigate excess medical expenditures associated with HL. Conflict of Interest: The study was supported by grants from the National Institute on Deafness and Other Communication Disorders (K23DC011279), Triological Society, and American College of Surgeons through a Clinician Scientist Award, and Eleanor Schwartz Charitable Foundation. Danielle Foley works for the Lewin Group, a healthcare consulting firm. The firm had no role in the development or sponsorship of this article. Frank Lin serves as a consultant to Cochlear Americas, is on the scientific advisory board of Pfizer and Autifony, and has been a speaker for Med El and Amplifon. Author Contributions: Ms. Foley and Dr. Lin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Frick, Lin. Acquisition of data: Foley. Statistical analysis: Foley, Lin. Analysis and interpretation of data: Foley, Frick, Lin. Drafting of the manuscript: Foley, Frick, Lin. Sponsor's Role: The sponsors had no role in the design or conduct of the study; collection, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.