Hearing Aid Use at the Intersection of Race, Ethnicity, and Socioeconomic Status (2024)

Racial and ethnic inequalities are pervasive across hearing health care, including hearing aid use.¹ There is a paucity of research on inequalities in hearing health care that consider the intersections of race, ethnicity, and socioeconomic status (SES).

We conducted a cross-sectional analysis of adults aged 65 years or older with audiometric hearing loss using data from the 2022 National Health and Aging Trends Study (NHATS), a nationally representative sample of adults 65 years or older.^2,3 In accordance with the Common Rule, this study was exempt from ethics review and informed consent requirement due to use of deidentified, publicly available secondary data. We followed the STROBE reporting guideline.

Primary exposures were self-reported race and ethnicity: Hispanic, non-Hispanic Black, non-Hispanic White, and other (American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and other [specified by participant or proxy]) and annual household income based on the 2022 federal poverty level (low, middle, or high). The primary outcome was hearing aid use, which was defined by self-reported hearing aid or other hearing device use within the past month.

We estimated predicted adjusted percentages (PAPs) using weighted multivariable logistic regression models adjusted for demographic, socioeconomic, and health characteristics to examine the association between each exposure and the primary outcome. Race models were then stratified by income. Survey weights were applied to generate nationally representative estimates. Analyses were completed using Stata 18.0 (StataCorp LLC).

Among 3054 participants, 1442 (51.3%) were males and 1612 (48.7%) were females, with a mean (SD) age of 80.2 (6.8) years. A lower proportion of racially and ethnically minoritized participants reported hearing aid use compared with White participants (Black: 9.3% [62], Hispanic: 9.9% [45], other: 14.4% [17] vs White: 31.8% [735]) (Table 1). Regression models suggest that Black and Hispanic participants reported lower use of hearing aids compared with White participants (PAP, 16.6 [95% CI, 11.1-22.1], 13.7 [95% CI, 7.9-18.6], and 30.1 [95% CI, 27.7-32.6], respectively) (Table 2). When stratified by income, Black and Hispanic participants consistently had lower self-reported hearing aid use compared with White participants (low income: 6.8 [95% CI, 0.0-16.4], 5.3 [95% CI, 0.0-12.6], and 21.8 [95% CI, 12.3-31.3], respectively; middle income: 11.3 [95% CI, 3.4-19.2], and 16.4 [95% CI, 3.9-28.8], and 23.8 [95% CI, 16.8-30.8], respectively; high income: 19.3 [95% CI, 13.1-25.6], 17.5 [95% CI, 9.6-25.4], and 32.9 [95% CI, 29.0-36.8], respectively) (Table 2).

In a nationally representative sample of US older adults, lower percentages of Black and Hispanic NHATS participants reported using a hearing aid compared with White participants. Similarly, Black and Hispanic participants across income levels had significantly lower self-reported hearing aid uptake than their White counterparts.

Given the persistence of racial gaps in hearing aid use after controlling for income and other socioeconomic factors, more nuanced investigations are needed into the implications of race, ethnicity, and SES for hearing aid use to elucidate barriers to uptake. While such racial gaps may be associated with economic factors and barriers to routine health care access, they are not fully explained by traditional indicators of SES, including income. Additionally, standard markers of high SES may not adequately characterize or quantify the relationships between SES and race.⁴ Future studies should consider factors such as economic hardship, wealth, access to bank credit, occupational or economic returns on education, and purchasing power.^4,5

Study limitations include use of aggregated race and ethnicity categories that may not represent the substantial variability in racial and ethnic minoritized communities and inability to account for immigration status, experience with and role of systemic and interpersonal discrimination and racism, and other social and environmental factors affecting hearing aid use. Future research is needed to explain the downstream implications of these factors. Nevertheless, these findings emphasize that racial and ethnic disparities in hearing aid use would likely persist without more targeted efforts to increase access and reduce inequalities for populations at risk for hearing loss.

Accepted for Publication: September 12, 2024.

Published: November 22, 2024. doi:10.1001/jamahealthforum.2024.3854

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Bessen S et al. JAMA Health Forum.

Corresponding Author: Sarah Bessen, MD, MPH, Johns Hopkins University, 601 N Caroline St, Baltimore, MD 21287 (sbessen2@jh.edu).

Author Contributions: Drs Bessen and Reed 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.

Concept and design: Bessen, Garcia Morales, Reed.

Acquisition, analysis, or interpretation of data: Bessen, Zhang, Garcia Morales, Akré.

Drafting of the manuscript: Bessen, Akré, Reed.

Critical review of the manuscript for important intellectual content: Bessen, Zhang, Garcia Morales, Reed.

Statistical analysis: Bessen, Zhang.

Supervision: Reed.

Conflict of Interest Disclosures: Dr Bessen reported receiving grants from the National Institute on Deafness and Other Communication Disorders during the conduct of the study. Dr Reed reported receiving grants from the National Institute on Aging of the National Institutes of Health and Scientific Advisory Board (Neosensory) 2021-2023 during the conduct of the study. No other disclosures were reported.

Data Sharing Statement: See the Supplement.