Racial/Ethnic and Socioeconomic Disparities in Hearing Care among Older Americans

Abstract

Objectives: Although hearing impairment is prevalent in older adults and may carry implications for cognitive, social, and physical functioning, little is known about hearing care among older minority adults. The aims of this study were: (1) describe factors that are associated with disparities in hearing health care among older adults and (2) assess the current reach of hearing care delivery to older adults. Methods: We analyzed nationally-representative, cross-sectional data from 1544 older adults ≥70 years with audiometry and hearing health care data from the 2005-2006, 2009-2010 National Health and Nutritional Examination Surveys. The 2 primary outcomes were recent hearing screening (≤4 years) and, for those with hearing loss, regular hearing aid use (≥5 h/wk in the past 12 months). Disparities-related covariates included demographics, insurance status, general health, and health care utilization. Results: Adjusting for age and better ear speech-frequency (0.5-4 kHz), pure tone average (PTA), race (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.21-2.33, Blacks compared with Whites) and education (OR = 1.63, 95% CI: 1.05-2.52 ≥college versus <high school), were associated with having a recent hearing screening. However, hearing aid use was associated with socioeconomic status (higher education, income, poverty-to-income ratios, having private insurance), and with race (Blacks OR = 0.42 [95% CI: 0.19-0.91] and Mexican Americans OR = 0.22 [95% CI: 0.06-0.74] versus Whites). In a multivariate analysis, adjusting for age, hearing loss, race/ethnicity, and socioeconomic status, Blacks were not more likely than Whites to use hearing aids despite higher levels of hearing screening (OR = 0.74, 95% CI: 0.28-1.93). Conclusions: With increasing populations of older minority adults and growing evidence of the detrimental effects of hearing loss, disparities in hearing health care represent critical areas for research and intervention.