title: The socioeconomic impact of hearing loss in U.S. adults.
abstract: OBJECTIVE
  To evaluate the associations between hearing loss and educational attainment, income, and unemployment/underemployment in U.S. adults.
  
  
  METHODS
  National cross-sectional survey.
  
  
  METHODS
  Ambulatory examination centers.
  
  
  METHODS
  Adults aged 20 to 69 years who participated in the 1999 to 2002 cycles of the NHANES (National Health and Nutrition Examination Survey) audiometric evaluation and income questionnaire (N = 3,379).
  
  
  METHODS
  Pure-tone audiometry, with hearing loss defined by World Health Organization criteria of bilateral pure-tone average of more than 25 dB (0.5, 1, 2, 4 kHz).
  
  
  METHODS
  Low educational attainment, defined as not completing high school; low income, defined as family income less than $20,000 per year; and unemployment or underemployment, defined as not having a job or working less than 35 hours per week.
  
  
  RESULTS
  Individuals with hearing loss had 3.21 times higher odds of low educational attainment (95% confidence interval [95% CI], 2.20-4.68) compared with normal-hearing individuals. Controlling for education, age, sex, and race, individuals with hearing loss had 1.58 times higher odds of low income (95% CI, 1.16-2.15) and 1.98 times higher odds of being unemployed or underemployed (95% CI, 1.38-2.85) compared with normal-hearing individuals.
  
  
  CONCLUSIONS
  Hearing loss is associated with low educational attainment in U.S. adults. Even after controlling for education and important demographic factors, hearing loss is independently associated with economic hardship, including both low income and unemployment/underemployment. The societal impact of hearing loss is profound in this nationally representative study and should be further evaluated with longitudinal cohorts. Received institutional review board approval (National Center for Health Statistics Institutional Review Board Protocol no. 98-12).
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Emmett
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D001301:Audiometry, Pure-Tone; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment; D005260:Female; D006306:Health Surveys; D034381:Hearing Loss; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014478:Unemployment; D014481:United States; D055815:Young Adult