Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years | Otolaryngology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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.


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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

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 (

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.

Lin  FR, Niparko  JK, Ferrucci  L.  Hearing loss prevalence in the United States.  Arch Intern Med. 2011;171(20):1851-1852. doi:10.1001/archinternmed.2011.506PubMedGoogle ScholarCrossref
Goman  AM, Reed  NS, Lin  FR.  Addressing estimated hearing loss in adults in 2060.  JAMA Otolaryngol Head Neck Surg. 2017;143(7):733-734. doi:10.1001/jamaoto.2016.4642PubMedGoogle ScholarCrossref
Lin  FR, Yaffe  K, Xia  J,  et al; Health ABC Study Group.  Hearing loss and cognitive decline in older adults.  JAMA Intern Med. 2013;173(4):293-299. doi:10.1001/jamainternmed.2013.1868PubMedGoogle ScholarCrossref
Lin  FR, Metter  EJ, O’Brien  RJ, Resnick  SM, Zonderman  AB, Ferrucci  L.  Hearing loss and incident dementia.  Arch Neurol. 2011;68(2):214-220. doi:10.1001/archneurol.2010.362PubMedGoogle ScholarCrossref
Lin  FR, Ferrucci  L.  Hearing loss and falls among older adults in the United States.  Arch Intern Med. 2012;172(4):369-371. doi:10.1001/archinternmed.2011.728PubMedGoogle ScholarCrossref
Wallhagen  MI, Strawbridge  WJ, Shema  SJ, Kurata  J, Kaplan  GA.  Comparative impact of hearing and vision impairment on subsequent functioning.  J Am Geriatr Soc. 2001;49(8):1086-1092. doi:10.1046/j.1532-5415.2001.49213.xPubMedGoogle ScholarCrossref
Dalton  DS, Cruickshanks  KJ, Klein  BE, Klein  R, Wiley  TL, Nondahl  DM.  The impact of hearing loss on quality of life in older adults.  Gerontologist. 2003;43(5):661-668. doi:10.1093/geront/43.5.661PubMedGoogle ScholarCrossref
Foley  DM, Frick  KD, Lin  FR.  Association between hearing loss and healthcare expenditures in older adults.  J Am Geriatr Soc. 2014;62(6):1188-1189. doi:10.1111/jgs.12864PubMedGoogle ScholarCrossref
Genther  DJ, Betz  J, Pratt  S,  et al; Health, Aging and Body Composition Study.  Association between hearing impairment and risk of hospitalization in older adults.  J Am Geriatr Soc. 2015;63(6):1146-1152. doi:10.1111/jgs.13456PubMedGoogle ScholarCrossref
Chien  W, Lin  FR.  Prevalence of hearing aid use among older adults in the United States.  Arch Intern Med. 2012;172(3):292-293. doi:10.1001/archinternmed.2011.1408PubMedGoogle ScholarCrossref
National Academies of Sciences, Engineering, and Medicine.  Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016.
President’s Council of Advisors on Science and Technology (US).  Aging America and Hearing Loss: Imperative of Improved Hearing Technologies. Washington, DC: Executive Office of the President, President’s Council of Advisors on Science and Technology; 2015.
Forum on Aging, Disability, and Independence; Board on Health Sciences Policy; Division of Behavioral and Social Sciences and Education; Institute of Medicine; National Research Council.  Hearing Loss and Healthy Aging: Workshop Summary. Washington, DC: The National Academies Press; 2014.
Cassel  C, Penhoet  E, Saunders  R.  Policy solutions for better hearing.  JAMA. 2016;315(6):553-554. doi:10.1001/jama.2016.0044PubMedGoogle ScholarCrossref
Warren  E, Grassley  C.  Over-the-counter hearing aids: the path forward.  JAMA Intern Med. 2017;177(5):609-610. doi:10.1001/jamainternmed.2017.0464PubMedGoogle ScholarCrossref
Huddle  MG, Goman  AM, Kernizan  FC,  et al.  The economic impact of adult hearing loss: a systematic review.  JAMA Otolaryngol Head Neck Surg. 2017;143(10):1040-1048. doi:10.1001/jamaoto.2017.1243PubMedGoogle ScholarCrossref
Simpson  AN, Simpson  KN, Dubno  JR.  Higher health care costs in middle-aged US adults with hearing loss.  JAMA Otolaryngol Head Neck Surg. 2016;142(6):607-609. doi:10.1001/jamaoto.2016.0188PubMedGoogle ScholarCrossref
DeFrank  JT, Bowling  JM, Rimer  BK, Gierisch  JM, Skinner  CS.  Triangulating differential nonresponse by race in a telephone survey.  Prev Chronic Dis. 2007;4(3):A60.PubMedGoogle Scholar
United States Department of Labor. Consumer Price Index. Washington, DC: US Bureau of Labor Statistics; 2016. Accessed September 20, 2017.
Quan  H, Li  B, Couris  CM,  et al.  Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.  Am J Epidemiol. 2011;173(6):676-682. doi:10.1093/aje/kwq433PubMedGoogle ScholarCrossref
Kleinman  LC, Norton  EC.  What’s the risk? a simple approach for estimating adjusted risk measures from nonlinear models including logistic regression.  Health Serv Res. 2009;44(1):288-302. doi:10.1111/j.1475-6773.2008.00900.xPubMedGoogle ScholarCrossref
Manning  WG, Mullahy  J.  Estimating log models: to transform or not to transform?  J Health Econ. 2001;20(4):461-494. doi:10.1016/S0167-6296(01)00086-8PubMedGoogle ScholarCrossref
Graubard  BI, Korn  EL.  Predictive margins with survey data.  Biometrics. 1999;55(2):652-659. doi:10.1111/j.0006-341X.1999.00652.xPubMedGoogle ScholarCrossref
Zou  G.  A modified Poisson regression approach to prospective studies with binary data.  Am J Epidemiol. 2004;159(7):702-706. doi:10.1093/aje/kwh090PubMedGoogle ScholarCrossref
Hosmer  DW, Lemeshow  S.  Confidence interval estimation of interaction.  Epidemiology. 1992;3(5):452-456. doi:10.1097/00001648-199209000-00012PubMedGoogle ScholarCrossref
Mohr  PE, Feldman  JJ, Dunbar  JL,  et al.  The societal costs of severe to profound hearing loss in the United States.  Int J Technol Assess Health Care. 2000;16(4):1120-1135. doi:10.1017/S0266462300103162PubMedGoogle ScholarCrossref
Stucky  SR, Wolf  KE, Kuo  T.  The economic effect of age-related hearing loss: national, state, and local estimates, 2002 and 2030.  J Am Geriatr Soc. 2010;58(3):618-619. doi:10.1111/j.1532-5415.2010.02746.xPubMedGoogle ScholarCrossref
Genther  DJ, Frick  KD, Chen  D, Betz  J, Lin  FR.  Association of hearing loss with hospitalization and burden of disease in older adults.  JAMA. 2013;309(22):2322-2324. doi:10.1001/jama.2013.5912PubMedGoogle ScholarCrossref
Deal  JA, Sharrett  AR, Albert  MS,  et al.  Hearing impairment and cognitive decline: a pilot study conducted within the atherosclerosis risk in communities neurocognitive study.  Am J Epidemiol. 2015;181(9):680-690. doi:10.1093/aje/kwu333PubMedGoogle ScholarCrossref
Livingston  G, Sommerlad  A, Orgeta  V,  et al.  Dementia prevention, intervention, and care.  Lancet. 2017;390(10113):2673-2734. doi:10.1016/S0140-6736(17)31363-6PubMedGoogle ScholarCrossref
Strawbridge  WJ, Wallhagen  MI, Shema  SJ, Kaplan  GA.  Negative consequences of hearing impairment in old age: a longitudinal analysis.  Gerontologist. 2000;40(3):320-326. doi:10.1093/geront/40.3.320PubMedGoogle ScholarCrossref
Sudore  RL, Schillinger  D.  Interventions to improve care for patients with limited health literacy.  J Clin Outcomes Manag. 2009;16(1):20-29.PubMedGoogle Scholar
Cohen  JM, Blustein  J, Weinstein  BE,  et al.  Studies of physician-patient communication with older patients: how often is hearing loss considered? a systematic literature review.  J Am Geriatr Soc. 2017;65(8):1642-1649. doi:10.1111/jgs.14860PubMedGoogle ScholarCrossref
Berkman  ND, Sheridan  SL, Donahue  KE, Halpern  DJ, Crotty  K.  Low health literacy and health outcomes: an updated systematic review.  Ann Intern Med. 2011;155(2):97-107. doi:10.7326/0003-4819-155-2-201107190-00005PubMedGoogle ScholarCrossref
Paasche-Orlow  MK, Wolf  MS.  The causal pathways linking health literacy to health outcomes.  Am J Health Behav. 2007;31(1)(suppl 1):S19-S26. doi:10.5993/AJHB.31.s1.4PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity



My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right