title: Association of hearing impairment and mortality in older adults.
abstract: BACKGROUND
  Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults.
  
  
  METHODS
  Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear.
  
  
  RESULTS
  Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL).
  
  
  CONCLUSIONS
  HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. dgenthe2@jhmi.edu.
authors.forename: Dane J
authors.initials: DJ
authors.lastname: Genther
authors.affiliation: Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Joshua
authors.initials: J
authors.lastname: Betz
authors.affiliation: Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pennsylvania. Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania.
authors.forename: Sheila
authors.initials: S
authors.lastname: Pratt
authors.affiliation: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. J. Paul Sticht Center on Aging, Winston-Salem, North Carolina.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Kritchevsky
authors.affiliation: Department of Epidemiology, University of Aberdeen, UK.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Martin
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.affiliation: Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Helzner
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Satterfield
authors.affiliation: Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Qian-Li
authors.initials: QL
authors.lastname: Xue
authors.affiliation: Department of Epidemiology and Biostatistics, Department of Psychiatry and Department of Neurology, University of California, San Francisco.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins Center on Aging and Health, Baltimore, Maryland. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology; D001299:Audiometry; D005260:Female; D034381:Hearing Loss / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology
keywords: Epidemiology; Longevity; Outcomes; Public health; Successful aging.