Hearing loss among older adults in the United States has become a major public health concern in recent years. Untreated hearing loss is associated with serious issues like depression, social isolation, and cognitive decline. However, despite the availability of hearing aids, fewer than 20% of adults with hearing loss choose to use them.
A new study led by Dr. Sarah Bessen and her team, published in JAMA Network Open, examines how hearing aid usage has changed between 2011 and 2022. The study reveals significant disparities in usage based on income and geographic location, indicating that access to hearing care remains a challenge for many.
Background
The study, conducted using data from the National Health & Aging Trends Study (NHATS), explored the trends in hearing aid use among U.S. adults aged 65 and older over a period of eleven years. NHATS is a nationally representative cohort study that tracks aging trends across the U.S. adult population. Dr. Bessen’s team used data from three different NHATS cycles: 2011, 2015, and 2022, to track changes in hearing aid usage across income groups and geographic regions, particularly distinguishing between metropolitan and nonmetropolitan residents.
While hearing aids are the primary treatment for hearing loss, their adoption has historically been low. The reasons for this include limited access to hearing care, especially in nonmetropolitan regions, and high costs, which disproportionately affect low-income individuals.
Research Methodology
The research employed a cross-sectional study design, examining hearing aid use across three waves of NHATS. The team categorized participants into different income brackets—low, middle, and high income—based on the federal poverty line. The team also classified participants as residing in either metropolitan or nonmetropolitan areas. Metropolitan areas were defined using the 2013 Rural-Urban Continuum Codes from the U.S. Department of Agriculture, which distinguishes counties based on their population density and urban proximity.
Participants in each NHATS wave were asked whether they had used a hearing aid or other hearing devices in the past month. Using complex analytical weights, the researchers accounted for the study’s sampling design to ensure national representativeness. Statistical analyses were performed using Stata, a widely used statistical software package.
Overall, the study involved 7,089 participants in 2011, 6,885 in 2015, and 5,459 in 2022, making it a large and reliable dataset to explore changes over time. Importantly, this study did not include the use of over-the-counter hearing aids, which became publicly available in October 2022, meaning the findings predominantly reflect the uptake of traditionally prescribed hearing aids.
Key Findings
One of the most striking findings from the study is the increase in hearing aid use over the 11-year period. In 2011, only 11.2% of adults aged 65 and older reported using hearing aids, but by 2022, this proportion had risen to 16.3%, representing a 45.5% increase. While this marks significant progress, the data also reveal disparities in hearing aid adoption based on both income and geography.
- Income Disparities: High-income individuals saw the most significant rise in hearing aid use, with rates increasing from 11.6% in 2011 to 17.9% in 2022. Middle-income individuals also experienced growth in hearing aid usage, but to a lesser degree, with an increase from 9.6% in 2011 to 13.8% in 2022. However, among low-income adults, hearing aid use showed minimal improvement, particularly in nonmetropolitan areas.
- Geographic Disparities: While hearing aid use increased across the board, individuals living in nonmetropolitan areas reported a higher overall prevalence of hearing aid use than those in metropolitan areas. However, hearing aid adoption grew faster among metropolitan residents (from 10.7% in 2011 to 16.1% in 2022) compared to nonmetropolitan residents (13.1% to 17.6%). The most concerning trend was observed among low-income individuals in nonmetropolitan areas, where hearing aid use actually declined by 15.2% during the study period.
The researchers suggest that the resource-intensive nature of obtaining hearing aids—requiring repeated visits to specialists, maintenance, and costly devices—likely explains the disparities observed.
Financial and geographic barriers remain significant, particularly for those in rural regions with lower income levels, where healthcare infrastructure may be limited.
Implications for Hearing Care Policy
Although initiatives such as the Over-the-Counter Hearing Aid Act of 2017 have been designed to expand access to hearing care, and broader policies like the Affordable Care Act and Medicaid expansion may have indirectly improved access, the study’s findings indicate the need for more targeted approaches. Hearing aid use remains disproportionately low among low-income groups overall, with a significant decrease in use observed among low-income adults residing in nonmetropolitan areas.
Additionally, the data does not reflect the impact of over-the-counter hearing aids, which only became available to the public in October 2022.
These findings highlight the necessity for more comprehensive strategies to address the financial and geographic barriers that hinder access to hearing aids, particularly for vulnerable populations. While current policies may have made some progress, they are insufficient in bridging the gap for low-income and rural populations. There is a clear need to develop more specific interventions, such as expanded coverage options and increased availability of hearing care services, especially in nonmetropolitan areas.
With an aging population and hearing loss on the rise, the need for accessible and affordable hearing care is more pressing than ever. Ensuring that all older adults, regardless of income or location, have the opportunity to benefit from hearing aids is a crucial step in promoting healthier aging and reducing the long-term effects of hearing loss.
Citation:
- Bessen SY, Zhang W, Garcia-Morales E, Deal JA, Reed NS. Hearing Aid Use Trends Among Older Adults by Income and Metropolitan vs Nonmetropolitan Residence. JAMA Network Open. 2024;7(9). doi:10.1001/jamanetworkopen.2024.36140.
