Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004

1 July 2008 | Volume 149 Issue 1

Background: Diabetes might affect the vasculature and neural system of the inner ear, leading to hearing impairment.

Objective: To determine whether hearing impairment is more prevalent among U.S. adults with diabetes.

Design: Cross-sectional analysis of nationally representative data.

Setting: National Health and Nutrition Examination Survey, 1999 to 2004.

Participants: 5140 noninstitutionalized adults age 20 to 69 years who had audiometric testing.

Measurements: Hearing impairment was assessed from the pure tone average of thresholds over low or mid-frequencies (500, 1000, and 2000 Hz) and high frequencies (3000, 4000, 6000, and 8000 Hz) and was defined as mild or greater severity (pure tone average >25 decibels hearing level [dB HL]) and moderate or greater severity (pure tone average >40 dB HL).

Results: Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity in the worse ear was 21.3% (95% CI, 15.0% to 27.5%) among 399 adults with diabetes compared with 9.4% (CI, 8.2% to 10.5%) among 4741 adults without diabetes. Similarly, age-adjusted prevalence of high-frequency hearing impairment of mild or greater severity in the worse ear was 54.1% (CI, 45.9% to 62.3%) among those with diabetes compared with 32.0% (CI, 30.5% to 33.5%) among those without diabetes. The association between diabetes and hearing impairment was independent of known risk factors for hearing impairment, such as noise exposure, ototoxic medication use, and smoking (adjusted odds ratios for low- or mid-frequency and high-frequency hearing impairment were 1.82 [CI, 1.27 to 2.60] and 2.16 [CI, 1.47 to 3.18], respectively).

Limitations: The diagnosis of diabetes was based on self-report. The investigators could not distinguish between type 1 and type 2 diabetes. Noise exposure was based on participant recall.

Conclusion: Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition.

Editors' Notes Context Previous studies have hinted at an association between diabetes mellitus and hearing impairment. Contribution Using data from a national survey, the investigators found a higher prevalence of hearing impairment among persons with diabetes than in those without diabetes (21% vs. 9%). Caution Diabetes was self-reported and was verified in only a small proportion of participants. The investigators did not distinguish between type 1 and type 2 diabetes. Implication Hearing impairment is common among adults with diabetes. —The Editors

 

Author and Article Information

From Social & Scientific Systems, Silver Spring, Maryland, and National Institute on Deafness and Other Communication Disorders and National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

Acknowledgment: The authors thank Danita Byrd-Holt, BBA, and Laura Fang, MS, for statistical programming support; Keith Rust, PhD, for statistical expertise and helpful comments; and Christa Themann, MS, for helpful comments on the manuscript and involvement in the design and management of the audiometric component of NHANES.

Grant Support: By contracts N001 DK12478 and HHSN 26720070000 1G from the National Institute of Diabetes and Digestive and Kidney Diseases (Dr. Bainbridge).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: All NHANES data, analytic guidelines, questionnaires, codebooks, and interview and examination manuals are publicly available at www.cdc.gov/nchs/about/major/nhanes/datalink.htm. Sample statistical code for the analysis of NHANES data is publicly available at www.cdc.gov/nchs/tutorials/Nhanes/index_current.htm.

Requests for Single Reprints: Kathleen E. Bainbridge, PhD, MPH, Social & Scientific Systems, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910; e-mail, kbainbridge{at}s-3.com.

Current Author Addresses: Dr. Bainbridge: Social & Scientific Systems, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910.

Mr. Hoffman: National Institute on Deafness and Other Communication Disorders, Executive Plaza South Building, Suite 400A, 6120 Executive Boulevard, MSC 7180, Bethesda, MD 20892-7180.

Dr. Cowie: National Institute of Diabetes and Digestive and Kidney Diseases, Democracy Plaza II, Room 691, 6707 Democracy Boulevard, MSC 5460, Bethesda, MD 20892-5460.

Author Contributions: Conception and design: K.E. Bainbridge, H.J. Hoffman, C.C. Cowie.

Analysis and interpretation of the data: K.E. Bainbridge, H.J. Hoffman, C.C. Cowie.

Drafting of the article: K.E. Bainbridge.

Critical revision of the article for important intellectual content: K.E. Bainridge, H.J. Hoffman, C.C. Cowie.

Final approval of the article: K.E. Bainbridge, H.J. Hoffman, C.C. Cowie.

Provision of study materials or patients: C.C. Cowie.

Statistical expertise: K.E. Bainbridge, H.J. Hoffman, C.C. Cowie.

Obtaining of funding: H.J. Hoffman, C.C. Cowie.

Administrative, technical, or logistic support: H.J. Hoffman, C.C. Cowie.

Collection and assembly of data: K.E. Bainbridge.