Hearing Loss and Associated 7-Year Cognitive Outcomes Among Hispanic and Latino Adults

Abstract

ImportanceHearing loss appears to have adverse effects on cognition and increases risk for cognitive impairment. These associations have not been thoroughly investigated in the Hispanic and Latino population, which faces hearing health disparities.ObjectiveTo examine associations between hearing loss with 7-year cognitive change and mild cognitive impairment (MCI) prevalence among a diverse cohort of Hispanic/Latino adults.Design, Setting, and ParticipantsThis cohort study used data from a large community health survey of Hispanic Latino adults in 4 major US cities. Eligible participants were aged 50 years or older at their second visit to study field centers. Cognitive data were collected at visit 1 and visit 2, an average of 7 years later. Data were last analyzed between September 2023 and January 2024.ExposureHearing loss at visit 1 was defined as a pure-tone average (500, 1000, 2000, and 4000 Hz) greater than 25 dB hearing loss in the better ear.Main outcomes and measuresCognitive data were collected at visit 1 and visit 2, an average of 7 years later and included measures of episodic learning and memory (the Brief-Spanish English Verbal Learning Test Sum of Trials and Delayed Recall), verbal fluency (word fluency—phonemic fluency), executive functioning (Trails Making Test–Trail B), and processing speed (Digit-Symbol Substitution, Trails Making Test–Trail A). MCI at visit 2 was defined using the National Institute on Aging-Alzheimer Association criteria.ResultsA total of 6113 Hispanic Latino adults were included (mean [SD] age, 56.4 [8.1] years; 3919 women [64.1%]). Hearing loss at visit 1 was associated with worse cognitive performance at 7-year follow-up (global cognition: β = −0.11 [95% CI, −0.18 to −0.05]), equivalent to 4.6 years of aging and greater adverse change (slowing) in processing speed (β = −0.12 [95% CI, −0.23 to −0.003]) equivalent to 5.4 years of cognitive change due to aging. There were no associations with MCI.Conclusions and relevanceThe findings of this cohort study suggest that hearing loss decreases cognitive performance and increases rate of adverse change in processing speed. These findings underscore the need to prevent, assess, and treat hearing loss in the Hispanic and Latino community.

Concerns Regarding Hearing Loss and Cognitive Outcomes

“…Despite the authors adjusting for a set of covariates in the regression model, residual confounding, a critical limitation in observational studies, may still be present. Cigarette smoke and air pollution are 2 major confounders that should be taken into consideration in the article by Stickel and colleagues . It is well established that cigarette smoke and air pollution exposure increase the risk of dementia and cognitive impairment .…”

“…To the Editor In a recent article, Stickel et al contributed to exploring the association of hearing loss with 7-year cognitive change and mild cognitive impairment risk among 6113 Hispanic and Latino adults using a large community cohort. The findings suggest that hearing loss is associated with decreased cognitive performance 7 years later and increased change (slowing) in processing speed.…”

“…Regarding air pollution, a previous nationwide study in Korea reported that long-term exposure to air pollutants, ie, particulate matter 10 μm, nitrogen dioxide, and sulfur dioxide, was associated with an increased risk of hearing loss in adults. To be more informative, we propose this issue be worth mentioning in the discussion of the findings by Stickel and colleagues …”

Concerns Regarding Hearing Loss and Cognitive Outcomes—Reply

“…We previously identified both null and potentially protective associations of apolipoprotein ε4 allele status on cognitive change dependent on genetic ancestry . Our primary aim of the present work was to characterize the associations between hearing loss and 7-year cognitive performance, cognitive change, and mild cognitive impairment prevalence. Examining potential modifiers, especially one as complicated as apolipoprotein ε4 status in a complexly genetically admixed population, was beyond the scope of the present study.…”

“…In Reply Wang and colleagues noted some concerns regarding our recent publication on the associations between hearing loss and 7-year cognitive outcomes among Hispanic/Latino adults enrolled in the Study of Latinos—Investigation of Neurocognitive Aging, an ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) . We appreciate the discourse and wish to speak to some of these concerns.…”