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. 2025 Jul 30;25(1):565.
doi: 10.1186/s12877-025-06208-w.

A composite risk score to identify older adults at high risk of hearing loss in a community screening program

Juan Juan Li #  1   2 , Wei Xiang Gao #  3 , Jiao Wang  3 , Yan Hong Zhang  1   2 , Fei Ji  4   5   6 , Yao Dan Yuan  7 , Peng Zhang  1   2 , Fang Ma  1   2 , Lin Xu #  8   9   10 , Xian Hai Zeng #  11   12
Affiliations

A composite risk score to identify older adults at high risk of hearing loss in a community screening program

Juan Juan Li et al. BMC Geriatr. .

Abstract

Background: Age-related hearing loss (HL) is highly prevalent among older adults, yet it often goes undetected and untreated. Routine screening in community settings is not widespread, and hearing aid uptake remains very low. We aimed to construct a composite risk score to identify individuals at high risk of HL for targeted audiometric screening.

Methods: We conducted a cross-sectional study using data from a community-based health screening program in Shenzhen, China. Participants underwent pure-tone audiometry at 500-8000 Hz to determine hearing thresholds. Moderate or greater HL was defined as a pure-tone average (PTA) ≥ 35dB in the better ear. Stepwise multivariable regression was used to identify predictors of HL, which were then used to develop a cumulative Hearing Risk Score (HRS).

Results: A total of 2,490 adults (mean age, 67.5 years, SD 5.8 years) were included; 32.5% (810 participants) had moderate or greater hearing loss. Of 22 risk factors included in the stepwise regression model, seven were identified: self-reported hearing difficulty, age 65 years or older, male sex, social isolation, cardiovascular disease, and metabolic disease. These were incorporated into the HRS, with total scores ranging from 1 to 23. The HRS was strongly associated with moderate or greater hearing loss, with adjusted odds ratios increasing from 4.50 (95% confidence interval (CI), 1.57-12.88) for a score of 1 to 39.11 (13.50-113.33) for a score of 6 or more (P for trend < 0.001). Similar dose-response patterns were observed at all frequencies tested (0.5 to 8 kHz).

Conclusions: The HRS showed a clear dose-response relationship with HL and may serve as a practical tool to target older adults for confirmatory audiologic evaluation.

Keywords: Hearing loss; Older adults; Risk score; Screening.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study followed the Declaration of Helsinki and informed consent was obtained from the participants. All participants provided informed consent for their health data to be used in research, and the study protocol was approved by the Ethics Committee of Longgang District Ear, Nose and Throat Hospital, Shenzhen. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Age- and sex-adjusted pure-tone hearing thresholds across risk score categories at 500, 1000, 2000, 4000, and 8000 Hz. Note: Error bars represent 95% confidence intervals. Hearing thresholds (in decibels, dB HL) were measured using pure-tone audiometry at the specified frequencies and adjusted for age and gender using linear regression. Risk scores reflect the cumulative number of hearing loss-related risk factors
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves for the Hearing Risk Score (HRS) and the Hearing Handicap Inventory for the Elderly (HHIE)
See this image and copyright information in PMC

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