Associations Between Hearing Loss and Dementia in a Large Electronic Health Record System

Abstract

Objectives: Epidemiologic analyses of hearing loss utilize national volunteer-based datasets that are restricted by limited variables and few individuals with severe disease. We overcome these limitations using two large electronic health records to study whether audiometric hearing loss is associated with dementia.

Methods: This was a cross-sectional, multicentered retrospective study using the electronic health records at the academic medical centers of Columbia University and Cornell University (n = 31,997 total) for participants ≥ 18 years old with clinical audiometry from February 1, 2020 through May 5, 2023. Hearing measures were from the better ear and included pure tone average, word recognition score, and speech reception threshold. Dementia was defined as ICD-10 diagnosis code only, dementia medications only, the presence of both conditions, and the presence of either condition. Odds ratios were computed from univariable and multivariable logistic regressions between hearing loss and dementia with 95% confidence intervals, using the covariates of age, sex, cardiovascular risk score, and site.

Results: The mean age (SD) in the combined dataset was 60.5 (18.3) years and 18,992 (59.4%) were women. All univariable regressions showed increased odds of dementia with worsening hearing, regardless of how hearing or dementia was defined. Controlling for covariates, for every 10-dB worsening in hearing by pure tone audiometry, the odds of dementia (as defined by ICD-code or medication list) increased by 1.11 times (95% CI = 1.07-1.16); for every 10% worsening in word recognition score, the odds of dementia increased by 1.06 times (95% CI = 1.01-1.11); for every 10-dB worsening of the speech reception threshold, the odds of dementia increased by 1.10 times (95% CI = 1.05-1.15).

Conclusions: Using a large electronic health record system, audiometric hearing loss defined in three separate ways was associated with increased odds of dementia. Electronic health records can corroborate and expand previously studied relationships between hearing loss and its comorbidities, including dementia.

Keywords: cognition; dementia; electronic health record III; hearing loss.