Hearing impairment and adult mortality: the role of co-impairments in understanding risk.

OBJECTIVES

This study investigates the association between hearing impairment and all-cause mortality before and after adjusting for other co-impairments related to vision, cognition, ambulatory, self-care, and independent living for a representative, restricted-use sample of United States adults aged 25 and older (N > 3,000,000).

METHODS

We use data from the Mortality Disparities in American Communities (MDAC) study, which links the 2008 American Community Survey to prospective mortality follow-up from 2008 to 2015. The risk of all-cause mortality is estimated using adjusted Cox Proportional Hazard models.

RESULTS

After adjusting for a wide range of social demographic and economic factors, adults with hearing impairment, relative to adults with none, had 21% higher risk of death from any cause. However, the presence of co-impairments fully explained the association between hearing impairment and mortality for the full sample and for sub-samples of working-age (25 to 64) and retirement-age (65 and older) adults.

DISCUSSION: The results suggest that hearing impairments are not likely to be direct determinants of mortality risk, but rather an indicator of overall health and of the differing pathways to current health status for younger and older adults. Future work should avoid essentializing the experiences of adults with hearing impairment and strive to distinguish between these pathways to deafness in efforts to better understand how access to supportive social networks impacts health.