Hearing Loss, Hearing Aid Use, and Risk of Dementia in Older Adults

Abstract

Importance: Hearing loss has been suggested as a risk factor for dementia, but there is still a need for high-quality research to better understand the association between these 2 conditions and the underlying causal mechanisms and treatment benefits using larger cohorts and detailed data.

Objective: To investigate the association between hearing loss and incident dementia, as well as how hearing aid use contributes to this association.

Design, setting, and participants: This population-based cohort study was conducted in Southern Denmark between January 2003 and December 2017 and included all residents 50 years and older. We excluded all persons with dementia before baseline as well as those who did not live in the region 5 years before baseline, with incomplete address history, or who had missing covariate information.

Exposures: Individual hearing status based on the Hearing Examinations in Southern Denmark database, which contains data on all pure-tone audiometry examinations performed at public hearing rehabilitation clinics in Southern Denmark.

Main outcomes and measures: Incident cases of dementia and Alzheimer disease as identified from national registries.

Results: The study population comprised 573 088 persons (298 006 women [52%]; mean [SD] age, 60.8 [11.3] years) with 23 023 cases of dementia and mean (SD) follow-up of 8.6 (4.3) years. Having a hearing loss was associated with an increased risk of dementia, with an adjusted hazard ratio (HR) of 1.07 (95% CI, 1.04-1.11) compared with having no hearing loss. Severe hearing loss in the better and worse ear was associated with a higher dementia risk, with an HR of 1.20 (95% CI, 1.09-1.32) and 1.13 (95% CI, 1.06-1.20), respectively, compared with having no hearing loss in the corresponding ear. Compared with people without hearing loss, the risk of dementia was higher among people with hearing loss who were not using hearing aids than those who had hearing loss and were using hearing aids, with HRs of 1.20 (95% CI, 1.13-1.27) and 1.06 (95% CI, 1.01-1.10), respectively.

Conclusions and relevance: The results of this cohort study suggest that hearing loss was associated with increased dementia risk, especially among people not using hearing aids, suggesting that hearing aids might prevent or delay the onset and progression of dementia. The risk estimates were lower than in previous studies, highlighting the need for more high-quality longitudinal studies.

Figure.. Exposure-Response Association Between Better Ear Pure-Tone Average (PTA) and Hazard Ratios for Dementia

In panel A, PTA was included as a time-constant variable, whereas in panel B, PTA was included as a time-varying variable. The exposure-response curves were built using natural cubic splines with 4 degrees of freedom, based on continuous PTA in the better ear and after adjusting for age (by design), sex, calendar year, cohabiting status, education, income, country of origin, occupational status, presence of cardiometabolic diseases, and area-level socioeconomic variables. The solid lines represent hazard ratios (HRs), whereas the dashed lines represent 95% CIs.