Factors Associated With Hearing Aid Use Among Medicare Beneficiaries

Abstract

Background and Objectives In the U.S., up to two-thirds of older adults have hearing loss. Untreated hearing loss can have significant health outcomes, yet less than 20% of adults with hearing loss use hearing aids. In this study, we examined potential factors associated with hearing aid use, including detailed measures of health status, access to care, patient engagement, and technology use, in a nationally representative sample of Medicare beneficiaries. Research Design and Methods Cross-sectional study using the 2017 Medicare Current Beneficiary Survey. Participants with self-reported hearing loss were included. The primary outcome was hearing aid use. Factors potentially associated with hearing aid use included: socio-demographics, health determinants, access to care, patient activation, and technology access/use. Results Overall, 5,146 participants were included. Of them, 27% reported using hearing aids. In a multivariable logistic regression model, predisposing factors associated with greater odds of hearing aid use included older age, identifying as a man, identifying as white, having completed college, having 3 or more chronic conditions, having dementia, not having trouble seeing, not having limitations in ADLs, having moderate relative to low information-seeking scores, and having a personal computer at home (range of odds ratios:1.22-4.46). Enabling factors associated with greater odds of hearing aid use included higher income, living alone relative to living with family members other than a spouse, and having a usual source of care (range of odds ratios: 1.43-1.54). Discussion and Implications In addition to addressing previously identified factors associated with hearing aid use, improving access to health care, technology, and information about hearing aids may improve the uptake of hearing aids. These findings help further inform our understanding on how to address low treatment levels of hearing loss in the community by identifying new populations to target and potentially modifiable risk factors for hearing aid use.

Socioeconomic position and hearing loss: current understanding and recent advances

“…Individuals were also less likely to have a recent hearing test if they also had low educational attainment [40,41]. In a nationally representative sample from the United States from 2011 to 2018, although overall ownership and use of hearing aids increased in the general population by 23.3%, those with lower income showed a decrease in proportional ownership and use of hearing aids [36].…”

“…This number is even lower for those with low income [8,13 ▪ ]. Individuals using hearing aids are more likely to have access to technology, a stronger commitment to learning and using technology, and respective social support of family and friends [36,48 ▪ ,49]. For individuals with low SEP, lack of access to technology and outside support may be a challenge in light of the OTC device market and may exacerbate existing disparities if follow-up services remain uncovered.…”

“…Disparities related to hearing aid use exist among those with low SEP. Individuals with lower education and lower income (less than 100% of the federal poverty level) are less likely to use hearing aids and those who have hearing aids are less likely to use them on a regular basis [8,13 ▪ ,36–38,39 ▪ ]. Those with lower income and Medicare coverage who reported having a hearing loss were less likely to have gone to an audiologist than individuals with high incomes [40].…”

Alternative Pathways for Hearing Care May Address Disparities in Access

“…Barriers to hearing aid use include high cost and lack of, or inadequate, insurance coverage, perceived stigma by others, significant resources required to navigate current processes, including transportation, mobility, and know-how as well as a lack of clear recommendations or guidance by primary care providers ( 13 , 14 ).…”

“…People with untreated hearing loss have different health care utilization patterns and costs compared to those without hearing loss, ( 24 ) and compared to those with hearing loss who use hearing aids ( 25 ). Those with untreated hearing loss are more likely to visit emergency departments ( 24 ), report unmet health care needs ( 26 ), and not have a usual source of care ( 14 ). Understanding how people with untreated hearing loss access the general health care system and what characteristics set them apart from those who already use hearing aids is fundamental to understanding how we can reach those Medicare beneficiaries with hearing loss who are not served by the current model of care.…”