Kathleen E. Bainbridge, PhD, MPH; Howard J. Hoffman, MA; Catherine C. Cowie, PhD, MPH
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, firstname.lastname@example.org.
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.
Diabetes might affect the vasculature and neural system of the inner ear, leading to hearing impairment.
To determine whether hearing impairment is more prevalent among U.S. adults with diabetes.
Cross-sectional analysis of nationally representative data.
National Health and Nutrition Examination Survey, 1999 to 2004.
5140 noninstitutionalized adults age 20 to 69 years who had audiometric testing.
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).
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).
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.
Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition.
Previous studies have hinted at an association between diabetes mellitus and hearing impairment.
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%).
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.
Hearing impairment is common among adults with diabetes.
Table 1. Functional Description of Hearing Impairment, by Severity of Impairment and Frequency Range
Table 2. Characteristics of the U.S. Population Age 20 to 69 Years, by Low- or Mid-Frequency Hearing Impairment of Mild or Greater Severity in the Worse Ear
Table 3. Prevalence of Hearing Impairment in U.S. Adults Age 20 to 69 Years, by Diagnosed Diabetes Status
Age-adjusted and age-specific mean within-person pure tone thresholds.
Values are averaged over both ears and presented by diagnosed diabetes status among U.S. adults, National Health and Nutrition Examination Survey, 1999–2004. dB HL = decibels hearing level. A. Participants age 20 to 69 years (n = 5140), age-adjusted to the 2000 U.S. Census. B. Participants age 20 to 29 years (n = 1209). This panel should be interpreted with caution; the data are based on only 10 people (most of whom probably have type 1 diabetes), and age differed between participants with diabetes and those without. C. Participants age 30 to 39 years (n = 1084). D. Participants age 40 to 49 years (n = 1036). E. Participants age 50 to 59 years (n = 838). F. Participants age 60 to 69 years (n = 973).
Table 4. Prevalence of Low- or Mid-Frequency Hearing Impairment of Mild or Greater Severity in the Worse Ear
Appendix Table 1. Prevalence of High-Frequency Hearing Impairment of Mild or Greater Severity in the Worse Ear
Appendix Table 2. Prevalence of Low- or Mid-Frequency Hearing Impairment of Moderate or Greater Severity in the Worse Ear
Appendix Table 3. Prevalence of High-Frequency Hearing Impairment of Moderate or Greater Severity in the Worse Ear
Appendix Table 4. Prevalence of Low- or Mid-Frequency Hearing Impairment of Mild or Greater Severity in the Better Ear
Appendix Table 5. Prevalence of High-Frequency Hearing Impairment of Mild or Greater Severity in the Better Ear
Appendix Table 6. Prevalence of Low- or Mid-Frequency Hearing Impairment of Moderate or Greater Severity in the Better Ear
Appendix Table 7. Prevalence of High-Frequency Hearing Impairment of Moderate or Greater Severity in the Better Ear
Appendix Table 8. Prevalence of Self-Reported Hearing Impairment
Table 5. Age-Adjusted Prevalence of High-Frequency Hearing Impairment, by Glycemic Status
Table 6. Multivariable-Adjusted Odds Ratios
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Diabetes patients should be screened for hearing loss.
Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med. 2008;149:1–10. doi: 10.7326/0003-4819-149-1-200807010-00231
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Published: Ann Intern Med. 2008;149(1):1-10.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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