Investigating ethnic inequalities in hearing aid use in England and Wales: a cross-sectional study

Abstract

Objective: To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults.Design: Cross-sectional data from the UK Biobank resource.Study sample: 164,786 participants aged 40-69 who answered hearing questions.Results: After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, ethnic inequalities were observed in both hearing aid use and self-reported hearing difficulty. There were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17-0.76), Black Caribbean (OR 0.37, 95% CI 0.22-0.64) and Indian (OR 0.59, 95% CI 0.41-0.85) ethnic groups, compared to the White British or Irish group. For equivalent levels of objectively assessed hearing, men from most ethnic minority groups, and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts.Conclusions: For equivalent levels of hearing loss, use of hearing aids is lower among ethnic minority groups.Inequalities are partly due to lower levels of self reported hearing difficulty among minority groups. However, even when self reported hearing difficulty considered, hearing aid use remains lower among many ethnic minority groups. As reasons for low hearing aid use in ethnic minorities may differ between groups, potential reasons for low use including barriers to services, the effect of discrimination, and attitudes to hearing loss and hearing aid use, should be explored using culturally safe methodology with each major UK ethnic group.

Socioeconomic Status Among Cochlear Implant Candidates and Association With Surgical Pursuance

“…The observed differential odds of cochlear implant candidacy across socioeconomic strata likely represent differences in the prevalence and severity of hearing loss, which have been demonstrated previously in the literature . Potential explanations for our demonstrated lower odds of surgery among candidates in lower income quintiles are manifold and deserve closer examination.…”

“…Socioeconomic status has been consistently shown to affect hearing health. The prevalence of hearing loss, discrepancies between self-perceived and actual hearing loss, and hearing aid use vary across racial and ethnic groups, income, and educational levels . Members of racial and ethnic minority groups are more likely to experience hearing loss for a long period of time before undergoing cochlear implantation and less likely to pursue cochlear implant surgery than White patients .…”

“…The observed differential odds of cochlear implant candidacy across socioeconomic strata likely represent differences in the prevalence and severity of hearing loss, which have been demonstrated previously in the literature. 13,[15][16][17][18][19][20][21] Potential explanations for our demonstrated lower odds of surgery among candidates in lower income quintiles are manifold and deserve closer examination. Health care attitudes, beliefs, and real or perceived barriers to care may contribute, and the relative contribution of these and other factors are likely not uniform across individuals in a given stratum.…”

“…Barriers to health care among low-SES populations may be direct—including poor transportation infrastructure and associated costs, insurance coverage, and competing social priorities—or indirect, wherein poor health literacy, life experiences, and one’s sociodemographic context may affect their health care perceptions, uptake of health care information, and ability or willingness to engage in health care interventions . Individuals with lower SES are not only more likely to experience hearing loss but also less likely to seek hearing aid rehabilitation . One study demonstrated that the odds of hearing loss were nearly twice as high in the lowest compared with the highest tertile of income after adjustment for other variables .…”

“…14 Individuals with lower SES are not only more likely to experience hearing loss but also less likely to seek hearing aid rehabilitation. 13,[15][16][17][18][19][20] One study demonstrated that the odds of hearing loss were nearly twice as high in the lowest compared with the highest tertile of income after adjustment for other variables. 21 Studies of pediatric patients [22][23][24] have suggested that affluence and insurance status affect whether a child with hearing loss will undergo cochlear implantation.…”