THE ECONOMIC EFFECT OF AGE‐RELATED HEARING LOSS: NATIONAL, STATE, AND LOCAL ESTIMATES, 2002 AND 2030

Abstract

To the Editor: Age-related hearing loss (mild to functionally deaf) affects approximately 18% of U.S. population aged 65 and older.1 After arthritis and hypertension, it is the third most commonly reported chronic condition in this age group.2 Although not life threatening, this condition can significantly diminish a person's quality of life and has been linked to depression, social isolation, and poor physical function in older adults.3–5 Moreover, care for hearing loss is typically paid out of pocket, adding significant financial burden to the individual.1,6 Few studies have examined the economic effect of this emerging public health problem.1,6 The present analysis addresses this gap by evaluating direct medical costs and costs attributable to lost productivity for this condition in the United States. Estimates are presented at the national, state, and local levels for 2002 and 2030, using California and Los Angeles (LA) County as illustrative cases. Using a stepwise, prevalence-based simulation model, national estimates of the prevalence of hearing loss in those aged 65 and older were applied to the national, California, and LA County populations for 2002 and 2030. Multiple data sources were used, including the 2000 U.S. Census, the Survey of Income and Program Participation, and the California Department of Finance. Total direct medical costs incurred during the first year of hearing loss treatment were estimated using California's Medicaid (Medi-Cal) coverage data. Included in these calculations were the costs for audiometric screening, diagnostic audiological evaluation, binaural hearing aids, and hearing aid fitting. Where appropriate, estimates were adjusted for healthcare inflation. For the 2030 estimates, factors such as the expected increase in life expectancy and the prevalence of preexisting hearing problems in present-day baby boomers (aged 45–64) who will reach age 65 by 2030 were accounted for. Lost productivity costs attributable to the group aged 65 and older were extrapolated using data previously collected.6 In 2002, approximately 6.4 million Americans aged 65 and older reported having some form of hearing loss (mildly to functionally deaf). The total costs of first-year treatment of this condition in this age group in 2002 was approximately $1,292 per person or $8.2 billion nationally, $855 million in California, or $229 million in LA County (Table 1). By 2030, these costs would increase to approximately $51.4 billion nationally, $6 billion in California, and $1.4 billion in LA County. It was also estimated that the 2002 lost productivity costs attributable to hearing loss in this age group were approximately $1.4 billion nationally, $149 million in California, and $40 million in LA County. By 2030, these costs would increase to $9 billion, $1 billion, and $253 million, respectively. These findings suggest that the financial and societal burden of treating age-related hearing loss will increase substantially in the upcoming decades. Much of this burden will fall disproportionally on older adults, because most public and private health plans provide minimal to no coverage for degenerative hearing loss. Poor and underserved older adults are likely to feel this burden the most, adding a new dimension to health disparities. Although these projections are conservative and probably underestimated the costs of hearing loss in the United States, they have policy and planning implications for many cities, community-based organizations, and agencies that provide services to older adults. For example, these data may assist advocacy groups or health professionals in their efforts to advocate for or implement best practices that help reduce modifiable risk factors of hearing loss such as smoking, uncontrolled diabetes mellitus, stroke, and occupational noise exposure.1,3 If adopted, this “preparative” approach may represent an important step toward reducing and controlling the economic and social costs of age-related hearing loss, hopefully making the condition a less isolating, painful experience. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to the analysis, interpretation, and presentation of the data and helped draft the letter or revised it critically for important intellectual content. This analysis was conducted as part of Dr. Stucky's medical school thesis (unpublished) at the Charles Drew University of Medicine and Science, College of Medicine. Sponsor's Role: No sponsor.