Modifiable Risk Factors and Hearing Loss: The National Health and Nutrition Examination Survey 1999–2020

OBJECTIVE: To explore the associations between major modifiable risk factors and hearing loss. METHODS: This serial cross-sectional study was conducted within the National Health and Nutrition Examination Survey 1999-2020 in the United States. Associations were assessed using modified Poisson regression and within-sample population attributable fraction (PAF). RESULTS: Eight thousand seven hundred and seventy adults aged 40-85 years were included in the analyses, the mean (SD) age was 58.0 (11.7) years, with 4002 men (45.6%). Hearing loss was associated with low educational attainment with prevalence ratio 1.23, 95% confidence interval (1.15, 1.31); low income 1.11 (1.04, 1.19); diabetes 1.10 (1.03, 1.18); HDL-C dyslipidaemia 1.13 (1.06, 1.21); obesity 1.08 (1.01, 1.15) and tobacco use 1.11 (1.04, 1.19). Within our analysis, over 25% of hearing loss cases were attributed to modifiable risk factors, with low education or income, HDL-C dyslipidaemia, obesity and tobacco use being the leading contributors, though relative rankings varied slightly in survey-weighted analyses. CONCLUSION: Hearing promotion policies should prioritise related modifiable factors to reduce the burden of hearing loss.