Synergistic effect of smoking on age-related hearing loss in patients with diabetes

Abstract

This study investigated the synergistic effects of risk factors on age-related hearing loss (ARHL) using nationwide cross-sectional data of 33,552 individuals from the 2010‒2013 Korea National Health and Nutrition Examination Survey. Patients with ARHL were selected based on their pure-tone audiometry results. Previously reported risk factors for ARHL were analyzed using logistic regression and propensity score-matching, and synergistic effects between risk factors were analyzed using propensity score-matching. Of the 12,570 individuals aged 40-79 years, 2002 (15.9%) met the criteria for ARHL. Male sex, exposure to occupational noise, and diabetes showed a significant relationship with ARHL (p < 0.05) in both the logistic regression and propensity score-matching analyses. Smoking and diabetes showed the strongest significant synergistic effect on ARHL (odds ratio [OR] 1.963, 95% confidence interval [CI] 1.285‒2.998; p = 0.002). In the subgroup analysis based on smoking status, current smokers with diabetes had a significant relationship with ARHL (OR 1.883, CI 1.191‒2.975; p = 0.009), whereas ex-smokers with diabetes did not (OR 1.250; CI 0.880‒1.775; p = 0.246). This implies that current smokers with diabetes may benefit from the cessation of smoking. In conclusion, patients with diabetes should strictly avoid or cease smoking to prevent the progression of ARHL.

Figure 1

Pure-tone audiograms of propensity score-matched individuals in the analysis of the current smokers and never-smoked subgroups. Among 12,570 enrolled patients, 2296 current smokers and 7414 never-smoked individuals were included in the subgroup analysis. Propensity score-matching (PSM) was performed for age, male sex, hypertension, dyslipidemia, stroke, cardiovascular diseases, occupational noise exposure, and obesity as risk factors. In the propensity score-matched subjects, pure-tone thresholds were compared according to (a) the presence of diabetes (PSM pairs = 794), (b) current smoking status (PSM pairs = 950; denoted as c-Smoker in the figure), and (c) the combination of diabetes and current smoking status (PSM pairs = 230). c-Smoker, current smoker; * p < 0.05, ** p < 0.005, *** p < 0.001; paired t-test. The error bar indicates standard deviation.