Gender Modifies the Association of Cognition With Age-Related Hearing Impairment in the Health and Retirement Study

Abstract

Introduction: Despite growing recognition of hearing loss as a risk factor for late life cognitive disorders, sex and gender analysis of this association has been limited. Elucidating this is one means to advocate for holistic medicine by considering the psychosocial attributes of people. With a composite Gender Score (GS), we aimed to assess this among aging participants (50+) from the 2016 Health and Retirement Study (HRS) cohort.Methods: The GS was derived from gender-related variables in HRS by factor analyses and logistic regression, ranging from 0 (toward masculinity) to 100 (toward femininity). GS tertiles were also used to indicate three gender types (GS tertile 1: lower GS indicates masculinity; GS tertile 2: middle GS indicates androgyny; GS tertile 3: higher GS indicates femininity). Univariate followed by multiple logistic regressions were used to estimate the Odds Ratio (OR) and 95% confidence intervals (CI) of cognitive impairment (assessed by adapted Telephone Interview for Cognitive Status) from hearing acuity, as well as to explore the interactions of sex and gender with hearing acuity. The risk of cognitive impairment among hearing-impaired participants was assessed using multivariable models including sex and gender as exposure variables.Results: Five variables (taking risks, loneliness, housework, drinking, and depression) were retained to compute the GS for each participant. The distribution of GS between sexes partly overlapped. After adjusting for confounding factors, the OR for cognitive impairment associated with hearing impairment was significantly higher (OR = 1.65, 95% CI: 1.26, 2.15), and this association was not modified by female sex (OR = 0.77, 95% CI: 0.46, 1.27), but by androgynous gender (OR = 0.44, 95% CI: 0.24, 0.81). In the multivariable models for participants with hearing impairment, androgynous and feminine gender, as opposed to female sex, was associated with lower odds of cognitive impairment (OR of GS tertile 2 = 0.59, 95% CI: 0.41, 0.84; OR of GS tertile 3 = 0.60, 95% CI: 0.41, 0.87; OR of female sex = 0.78, 95% CI: 0.57, 1.08).Conclusions: Hearing impairment was associated with cognitive impairment among older people, and this association may be attenuated by a more feminine GS.

Progression and trajectory network of age-related functional impairments and their associations with mortality: a two-decade prospective study

“…The incidence rates reported in this study were comparable with previous studies. 37 38 39 40 41 42 43 44 45 For instance, the incidence rate of cognitive impairment was 52.6 cases/1000 person-years in a 5-year follow-up study of Aboriginal Australians aged over 60 years, 46 which is similar to our result (64.6 cases/1000 person-years). The observed sex- and age-disparities in incidence rates also corresponded to prior knowledge.…”

“…16 Using claim data, Jin and colleagues also conducted a network analysis for diseases with strong associations. 18 We assessed the associations between ARFIs, based on previous studies that have discovered unidirectional 44 45 51 52 or bidirectional relations between sensory impairments, such as vision and hearing, depression, and cognitive impairment. 44 45 51 53 54 For example, a meta-analysis of longitudinal studies indicated that visual impairment was associated with a 66% higher risk of cognitive impairment, and that cognitive impairment was also associated with the incidence of visual impairment.…”

Association of perception of patient‐centered care with hearing loss by race

“…Respondents indicated whether or not they heard each tone. Consistent with previous work, we defined hearing less than all 6 tones in the best ear as possible hearing loss 5,6 …”

“…Consistent with previous work, we defined hearing less than all 6 tones in the best ear as possible hearing loss. 5,6 Logistic regression was used to characterize the association of suboptimal perception of patient-centered care by hearing status. Covariates included: age, sex, race/ethnicity, marital status, educational attainment, insurance status, has usual source of care, and number of self-reported chronic comorbidities.…”

Progression and trajectory network of age-related functional impairments and their combined associations with mortality

“… 15 Using claim data, Jin and colleagues also conducted a network analysis for diseases with strong associations. 33 We assessed the associations between ARFIs, based on previous studies that have discovered unidirectional 36 , 37 , 38 or bidirectional relations between sensory impairments, such as vision and hearing, depression, and cognitive impairment. 36 , 37 , 38 , 39 , 40 For example, a meta-analysis of longitudinal studies indicated that visual impairment was associated with a 66% higher risk of cognitive impairment, and that cognitive impairment was also associated with the incidence of visual impairment.…”