Hearing Loss in Older Adults: Consistent Determinants Across Two Community-Based Cohorts in Southern China.

BACKGROUND

Hearing loss (HL) is common in older adults and is associated with substantial functional decline, yet community-based evidence on its determinants remains limited in China, particularly across different methods of hearing assessment.

OBJECTIVES

To investigate associations and predictors of HL among older adults in southern China using audiometric and self-reported assessments, and to compare patterns across two community-based cohorts.

METHODS

Data were analyzed from 2664 adults aged ≥ 60 years in Shenzhen and 30,518 adults aged ≥ 50 years from the Guangzhou Biobank Cohort Study (GBCS). Moderate-to-severe HL was defined as a pure-tone average (PTA) ≥ 35 dB hearing level in the better-hearing ear, calculated from air-conduction thresholds at 500-8000 Hz. HL was assessed using pure-tone audiometry in Shenzhen and a validated self-reported measure in GBCS. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Extreme gradient boosting with SHAP values was used to assess predictor importance.

RESULTS

Older age, male sex, and lower household income were consistently associated with higher odds of HL in both cohorts. In Shenzhen, metabolic disease (aOR = 1.28, 95% CI: 1.05-1.57) and otitis media (aOR = 2.65, 95% CI: 1.63-4.33) were positively associated with HL, whereas thyroid disease showed an inverse association. In GBCS, alcohol consumption (aOR = 1.28, 95% CI: 1.15-1.43), arthritis (aOR = 1.37, 95% CI: 1.23-1.52), and stroke (aOR = 1.64, 95% CI: 1.06-2.45) were positively associated, while overweight status and nonmanual occupation were inversely associated. Machine-learning analyses consistently identified age, sex, education, income, and chronic diseases as key predictors.

CONCLUSIONS

HL in older adults shows both shared and cohort-specific associations across assessment methods, highlighting sociodemographic and health-related disparities. Targeted community-based screening and prevention strategies are warranted.