Foundational Approaches to Advancing Hearing Health Equity: A Primer in Social Epidemiology

Abstract

Hearing health is inextricably linked to factors beyond biology. Social, demographic, environmental, geographic, and historical influences affect hearing health, but these factors are often unmeasured within traditional biological, clinical, and epidemiological studies of hearing health. With increasing recognition of hearing health over the life course as a public health priority, there is also a growing understanding of existing hearing health inequities at the individual, community, national, and global levels. To make progress in addressing these inequities, public health disciplines, such as social epidemiology, can provide valuable frameworks. With a focus on integrating the biological and functional with social and structural factors influencing health, social epidemiology provides key concepts and approaches for filling existing research and practice gaps. In this review, we introduce the discipline of social epidemiology and its associated concepts to inspire greater cross-disciplinary collaboration for the ultimate goal of advancing hearing health equity.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

“…To our knowledge, an intersectional framework has yet to be applied to hearing science or audiologic rehabilitation research. Consideration of intersectionality will be important to advance inclusion, diversity, equity and accessibility so that we may better understand the barriers to healthy hearing and construct policies, programs, and rehabilitation approaches that work for everyone, including those with overlapping layers of disadvantage (Nieman et al 2022; Schuh & Bush 2022).…”

Socioeconomic position and hearing loss: current understanding and recent advances

“…Levels of social-structural factors (macro and mezzo) interacting with individual-function (micro) and biological processes to impact health and society. Adapted with permission from Nieman et al [10 ▪ ].…”

“…Social epidemiology, or the study of factors in our social environment affecting patterns of disease, acknowledges the roles of structural and social elements at the macro level and mezzo level in society that contribute to changes in the development of disease and health outcomes in various populations [9,10 ▪ ]. Figure 1 provides a visual representation of the differing societal levels affecting health outcomes.…”

“…Whenever considering SEP in hearing health research, either as a reader or investigator, one must critically evaluate the appropriateness of the selected measures, including the study population, the underlying theoretical framework, and the hypothesized mechanism for SEP's effect on the measured outcome [10 ▪ ]. Examples of different SEP measures over the life course are shown in Fig.…”

Editorial: Ear and Hearing’s Commitment to Promoting Inclusion, Diversity, Equity, and Accessibility in Research on Hearing and Hearing Healthcare

“…Our goal for the IDEA supplement is to provide examples of research approaches incorporating IDEA considerations and evidence to illustrate the influence of IDEA on outcomes. The first two of the four papers in the supplement set the stage by providing overviews to illustrate the relevance of social epidemiology (Nieman et al 2022, this issue, pp. 33S–44S) and SDOH (Schuh & Bush 2022, this issue, pp.…”