Abstract
BackgroundHearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over.MethodsWe used the full dataset (74,699 person-years) of self-reported hearing data from all eight Waves of the English Longitudinal Study of Ageing (ELSA) (2002–2017). We examined the geographical identifiers of the participants at the Government Office Region (GOR) level and the geographically based Index of Multiple Deprivation (IMD). The primary outcome measure was self-reported HL; it consisted of a merged category of people who rated their hearing as fair or poor on a five-point Likert scale (excellent, very good, good, fair or poor) or responded positively when asked whether they find it difficult to follow a conversation if there is background noise (e.g. noise from a TV, a radio or children playing).ResultsA marked elevation in HL prevalence (10.2%) independent of the age of the participants was observed in England in 2002–2017. The mean HL prevalence increased from 38.50 (95%CI 37.37–39.14) in Wave 1 to 48.66 (95%CI 47.11–49.54) in Wave 8. We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants in the most deprived (IMD) quintile, in routine or manual occupations and misusing alcohol. The adjusted HL predictions at the means (APMs) showed marked regional variability and hearing health inequalities between Northern and Southern England that were previously unknown.ConclusionsA sociospatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities. The Clinical Commissioning Groups (CCGs) currently responsible for the NHS audiology services in England should not consider HL an inevitable accompaniment of older age; instead, they should incorporate socio-economic factors and modifiable lifestyle behaviours for HL within their spatial patterning in England.
Highlights
Hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England
The results of one-way analysis of variance (ANOVA) indicated that the null hypothesis was not rejected in Waves 2, 6, 7 and 8, which means that there is sufficient evidence to conclude that the means of age among Government Office Region (GOR)’ samples were equal [27]
We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants (a) in the most deprived (IMD) quintile, (b) in routine or manual occupations and (c) that misused alcohol, irrespective of socio-economic position (SEP)
Summary
Hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over. Scientific thinking in HL research was formed in previous decades around the concepts of older age and the male sex being the main leading causes of HL in adults, with little or no consideration for modifiable risk factors for hearing acuity. The study of Davis did not consider in its estimations the effects of place and socio-economic factors such as high occupational noise exposure from manual occupations [9] and differences in regions with strong and weak manufacturing industries [10]
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