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Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years

Educational Objective
To investigate the association between untreated hearing loss and healthcare costs and utilization over a 10-year period.
1 Credit CME
Key Points

Question  Is untreated hearing loss associated with higher health care costs and utilization?

Findings  In this retrospective, propensity-matched cohort study of claims data, compared with no hearing loss, untreated hearing loss was associated with higher health care costs and a higher risk of 30-day hospital readmission over a 10-year period.

Meaning  Untreated hearing loss may contribute to greater health care costs and utilization.

Abstract

Importance  Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.

Objective  To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.

Design, Setting, and Participants  Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.

Exposures  Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.

Main Outcomes and Measures  Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.

Results  Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.

Conclusions and Relevance  Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.

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Article Information

Accepted for Publication: August 26, 2018.

Corresponding Author: Nicholas S. Reed, AuD, Johns Hopkins University, Cochlear Center for Hearing and Public Health, 2024 E Monument Street, Baltimore, MD 21205 (nreed9@jhmi.edu).

Published Online: November 8, 2018. doi:10.1001/jamaoto.2018.2875

Author Contributions: Drs Altan and Kravetz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Reed, Yeh, Kravetz, Wallhagen, Lin.

Acquisition, analysis, or interpretation of data: Reed, Altan, Deal, Yeh, Kravetz, Wallhagen.

Drafting of the manuscript: Reed, Altan, Kravetz, Wallhagen.

Critical revision of the manuscript for important intellectual content: Reed, Altan, Deal, Yeh, Wallhagen, Lin.

Statistical analysis: Altan, Kravetz.

Administrative, technical, or material support: Altan, Yeh, Lin.

Study supervision: Reed, Altan, Yeh, Lin.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Reed reports grants from NIH KL2TR001077 during the conduct of the study and Scientific Advisory Board Member (nonfinancial relationship) to Clearwater Clinical. Dr Altan is an employee of OptumLabs. The AARP is a research partner and founding consumer advocate in OptumLabs and as a partner they fund 2 full-time equivalents to work on various projects in health care policy for the aging. Dr Altan’s work on this project was a part of that 2 full-time equivalent allotment. However, employment with OptumLabs was not dependent on that funding and the funding support work on multiple projects being conducted at OptumLabs. Dr Yeh reports a vendor client relationship with Hear USA that provides hearing services to AARP members. Dr Wallhagen is on the Board of the Hearing Loss Association of America in a noncompensated position and receives no payments and pay for all travel and other expenses. Dr Lin reports grants from National Institutes of Health and grants from Eleanor Schwartz Charitable Foundation during the conduct of the study; personal fees from Cochlear Ltd, personal fees from Amplifon, and personal fees from Boehringer Ingelheim outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by AARP and AARP Services, Inc. Dr Reed was supported by NIH grant NIH KL2TR001077. Dr Deal was supported by NIH/NIA grant K01AG054693. Dr Lin was supported by R01AG055426, R01HL096812, R33DC015062, and the Eleanor Schwartz Charitable Foundation. Drs Deal, Reed, and Lin were supported in part by the Cochlear Center for Hearing and Public Health.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors thank Tanya Natwick, BA, (OptumLabs) for her assistance in final preparation of this manuscript. Ms Natwick received no additional compensation beyond that of the regular course of her employment for her assistance with this article.

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