Regional patterns and trends of hearing loss in England: evidence from the English longitudinal study of ageing (ELSA) and implications for health policy

Abstract

Background Hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over. Methods We used the full dataset (74,699 person-years) of self-reported hearing data from all eight Waves of the English Longitudinal Study of Ageing (ELSA) (2002–2017). We examined the geographical identifiers of the participants at the Government Office Region (GOR) level and the geographically based Index of Multiple Deprivation (IMD). The primary outcome measure was self-reported HL; it consisted of a merged category of people who rated their hearing as fair or poor on a five-point Likert scale (excellent, very good, good, fair or poor) or responded positively when asked whether they find it difficult to follow a conversation if there is background noise (e.g. noise from a TV, a radio or children playing). Results A marked elevation in HL prevalence (10.2%) independent of the age of the participants was observed in England in 2002–2017. The mean HL prevalence increased from 38.50 (95%CI 37.37–39.14) in Wave 1 to 48.66 (95%CI 47.11–49.54) in Wave 8. We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants in the most deprived (IMD) quintile, in routine or manual occupations and misusing alcohol. The adjusted HL predictions at the means (APMs) showed marked regional variability and hearing health inequalities between Northern and Southern England that were previously unknown. Conclusions A sociospatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities. The Clinical Commissioning Groups (CCGs) currently responsible for the NHS audiology services in England should not consider HL an inevitable accompaniment of older age; instead, they should incorporate socio-economic factors and modifiable lifestyle behaviours for HL within their spatial patterning in England.

Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

“…These differences do not only reflect the differences in the health systems and hearing aid provisions among countries, as suggested by Sawyer et al. (2020) , but also emphasize individuals’ inability to identify their hearing difficulties as a barrier in their help-seeking process, even in countries where the hearing aids are available free of charge ( Tsimpida et al., 2020a ).…”

“…More recently, the term of lifestyle-related hearing loss has been added to the literature, where lifestyle refers to social practices and ways of living adopted by individuals that reflect personal, group and socioeconomic identities ( Tsimpida et al., 2019b ). The term incorporated the notion of socioacusis by including the hearing loss cases that develop due to exposures to sociospatial and modifiable lifestyle factors ( Tsimpida et al., 2020b ). In practice, many actions could be taken on several levels to make social listening safe, in terms of intensity, duration, and frequency of exposure to sounds ( WHO, 2015b ).…”

The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA)

“…The Cochrane review of Ferguson et al [ 18 ] had concluded, however, that the quality of evidence for the impact of hearing aids on the adverse effects of HL is very low; thus, large prospective studies are needed to raise the current quality of evidence [ 19 ] and further explore the potential moderating effect of hearing aids on the association between HL and depression. Given the rising prevalence of HL potentially due to social and lifestyle factors [ 2 , 20 ], it is crucial to fill the above knowledge gaps, as depression and HL are responsible for enormous public health costs, morbidity and mortality [ 21 ].…”