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.

Keywords: Health and Retirement Study (HRS); aging; cognitive impairment; gender; hearing impairment; risk factor; sex.

Figure 1

Flow diagram of subject selection from the 2016 HRS core. HRS, Health and Retirement Study.

Figure 2

GS distribution of 2016 HRS participants of both sexes (n = 2,912). GS, Gender Score; HRS, Health and Retirement Study.

Figure 3

Fitted cognitive testing scores as the increase of the age of participants, by hearing acuity, sex and gender, 2016 HRS (n = 2,912). (A) Fitted cognitive decline as the age of participants with normal hearing increases by sex; (B) Fitted cognitive decline as the age of HRS participants with hearing impairment increases by sex; (C) Fitted cognitive decline as the age of HRS participants with normal hearing increases by GS tertile; (D) Fitted cognitive decline as the age of HRS participants with hearing impairment increases by GS tertile. GS, Gender Score; HI, hearing impairment; HRS, Health and Retirement Study.

Figure 4

Incidence of cognitive impairment among HRS participants by sex and hearing acuity at the age of (A) 50–59, (B) 60–69, (C) 70–79, and (D) 80 or older, 2016 HRS (n = 2,912). *P < 0.05, ***P < 0.001. HI, hearing impairment; HRS, Health and Retirement Study.

Figure 5

Incidence of cognitive impairment among HRS participants by gender and hearing acuity at the age of (A) 50–59, (B) 60–69, (C) 70–79, and (D) 80 or older, 2016 HRS (n = 2,912). *P < 0.05, **P < 0.01, ***P < 0.001. HI, hearing impairment; HRS, Health and Retirement Study; GS, Gender Score.