title: Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.
abstract: OBJECTIVE
  To evaluate and compare the effects of cardiovascular risk factors (hypertension, smoking, diabetes) and noise exposure (occupational, recreational, firearm) on frequency-specific audiometric thresholds among US adults while assessing synergistic interactions between these exposures.
  
  
  METHODS
  National cross-sectional survey.
  
  
  METHODS
  United States adults aged 20 to 69 years who participated in the 1999 to 2002 National Health and Nutrition Examination Survey (N = 3,527).
  
  
  METHODS
  Air-conduction thresholds at 0.5 to 8 kHz (dB) in the poorer-hearing ear. Multivariate models adjusted for age, sex, race/ethnicity, and educational level.
  
  
  RESULTS
  : Exposure to firearm noise was significantly associated with high-frequency (4-8 kHz) hearing loss (HL), whereas smoking and diabetes were associated with significantly increased hearing thresholds across the frequency range (0.5-8 kHz). A significant interaction was observed between exposure to firearm noise and heavy smoking such that firearm noise was associated with a mean 8-dB hearing loss in heavy smokers compared with a mean 2-dB hearing loss in nonsmokers at 8 kHz. We also observed significant interactions between firearm noise exposure and diabetes.
  
  
  CONCLUSIONS
  Noise exposure was associated with high-frequency HL, whereas cardiovascular risk generated by smoking and diabetes was associated with both high- and low-frequency HL. The frequency-specific effects of these exposures may offer insight into mechanisms of cochlear damage. We demonstrated an interaction between cardiovascular risk and noise exposures, possibly as a result of cochlear vulnerability due to microvascular insufficiency. Such significant interactions provide proof of principle that certain preexisting medical conditions can potentiate the effect of noise exposure on hearing. Data-based stratification of risk should guide our counseling of patients regarding HL.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. yagrawa1@jhmi.edu
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Platz
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D001309:Auditory Threshold; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004781:Environmental Exposure; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009622:Noise / Q000009:adverse effects; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult