0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

The Prevalence of Concurrent Hearing and Vision Impairment in the United States FREE

Bonnielin K. Swenor, MPH; Pradeep Y. Ramulu, MD, PhD; Jeffery R. Willis, MD, PhD; David Friedman, MD, PhD, MPH; Frank R. Lin, MD, PhD
[+] Author Affiliations

Author Affiliations: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (Ms Swenor and Drs Friedman and Lin), and Dana Center for Preventive Ophthalmology, Wilmer Eye Institute (Ms Swenor and Drs Ramulu, Willis, and Friedman), and Department of Otolaryngology–Head and Neck Surgery (Dr Lin), Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, Maryland.


JAMA Intern Med. 2013;173(4):312-313. doi:10.1001/jamainternmed.2013.1880.
Text Size: A A A
Published online

The prevalence of dual sensory impairment (DSI) in hearing and vision has been estimated previously using self-reported data,1 nonrepresentative population samples,2 or populations outside of the United States.3 These estimates may not accurately reflect the true burden of DSI in the United States. We determined the prevalence of DSI using objective assessments of hearing and vision in a nationally representative sample of US adults.

We analyzed data from the 1999-2006 cycles of the National Health and Nutritional Examination Surveys (NHANES), a study designed to assess the health of a nationally representative sample of noninstitutionalized, civilian US residents.4

Air conduction pure-tone audiometry performed in a sound attenuating booth was administered to a half-sample of all participants aged 20 to 69 years from 1999 through 2004 and all participants 70 years or older from 2005 through 2006 according to established NHANES protocols. A speech-frequency pure-tone average (average of hearing thresholds at 0.5, 1, 2, and 4 kHz) greater than 25 dB in the better ear was defined as hearing impairment per World Health Organization criteria.5

For all participants 20 years or older from 1999 through 2006, visual acuity was determined for each eye using the individual's presenting correction (if any) and reassessed after autorefraction in eyes with a presenting acuity worse than 20/25.4 Visual impairment was defined by having a postautorefraction visual acuity worse than 20/40 in the better-seeing eye.

Four categories of sensory impairment were defined: DSI (concurrent hearing and vision impairment); hearing impairment (HI); vision impairment (VI); and no impairment (neither hearing nor vision impairment). Prevalence estimates were determined by age decade and sex. The US population counts were estimated using the midpoint of population totals in each NHANES cycle and averaged across combined cycles when appropriate. We accounted for the complex sampling design in all analyses by using sample weights according to National Center for Health Statistics guidelines.

We estimate that from 1999 through 2006 approximately 1.5 million Americans 20 years or older had DSI, with nearly all affected individuals being older adults (Table). For individuals younger than 70 years, the prevalence of DSI was less than 1%, but among individuals 80 years or older, 11.3% had DSI, and only 19% remained free of having any sensory impairment. Prevalence rates for DSI were not substantively different between men and women at any age decade. At each age decade, the prevalence of HI was greater in men than in women; however, the prevalence of VI was not different between men and women at any age.

Table Graphic Jump LocationTable. Prevalence (%) and Number (in Millions) of Adults by Hearing and Vision Impairment Status: National Health and Examination Surveys, 1999 Through 2006a

To our knowledge, this study presents the first national prevalence estimates of DSI in the United States based on objective data. Our results demonstrate that 1 in 9, or 11.3%, of all adults 80 years or older has prevalent DSI. This estimate is substantially higher than previous national estimates of DSI based on self-reported impairment among older adults1 (6.6%). Other estimates of DSI prevalence using objective assessments were based on a cohort of veterans2 or an Australian population3 and may not be generalizable to US adults.

Despite the relatively high prevalence in older adults, there is an inadequate understanding of the impact of DSI on cognition and physical functioning. Concurrent vision impairment could potentially accelerate the rate of cognitive decline and dementia previously reported in individuals with hearing impairment alone.6 There is also a lack of research examining how to effectively treat or rehabilitate older adults with DSI. Interdisciplinary, collaborative research efforts between ophthalmologists, otolaryngologists, and geriatricians are urgently needed to investigate the impacts of DSI, as well as to examine possible treatment and rehabilitative strategies in older adults.

Correspondence: Ms Swenor, Wilmer Eye Institute, School of Medicine, The Johns Hopkins Hospital, Woods 172, 600 N Wolfe St, Baltimore, MD 21287 (bswenor@jhmi.edu).

Published Online: January 21, 2013. doi:10.1001/jamainternmed.2013.1880

Author Contributions: Ms Swenor had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Swenor, Ramulu, Friedman, and Lin. Acquisition of data: Ramulu, Willis, and Friedman. Analysis and interpretation of data: Swenor, Willis, Friedman, and Lin. Drafting of the manuscript: Swenor. Critical revision of the manuscript for important intellectual content: Swenor, Ramulu, Willis, Friedman, and Lin. Statistical analysis: Swenor, Willis, Friedman, and Lin. Study supervision: Ramulu, Friedman, and Lin.

Conflict of Interest Disclosures: Dr Lin is a consultant to Pfizer and Cochlear Corp.

Funding/Support: This work was supported by grant T32AG000247 from the National Institutes of Aging, Research to Prevent Blindness Special Scholar Award, and NIH grant EY018595. Dr Lin was supported by NIH K23DC011279 and a Triological Society/American College of Surgeons Clinician Scientist Award.

Role of the Sponsors: The funders had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Caban AJ, Lee DJ, Gómez-Marín O, Lam BL, Zheng DD. Prevalence of concurrent hearing and visual impairment in US adults: the National Health Interview Survey, 1997-2002.  Am J Public Health. 2005;95(11):1940-1942
PubMed   |  Link to Article
Smith SL, Bennett LW, Wilson RH. Prevalence and characteristics of dual sensory impairment (hearing and vision) in a veteran population.  J Rehabil Res Dev. 2008;45(4):597-609
PubMed   |  Link to Article
Harada S, Nishiwaki Y, Michikawa T,  et al.  Gender difference in the relationships between vision and hearing impairments and negative well-being.  Prev Med. 2008;47(4):433-437
PubMed   |  Link to Article
Centers for Disease Control and Prevention (CDC).  National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: US Dept of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhanes.html. Accessed June 1, 2012
World Health Organization (WHO) Prevention of Blindness and Deafness Program.  Prevention of deafness and hearing impaired grades of hearing impairment. http://www.who.int/pbd/deafness/hearing_impairment_grades/en/index.html. Accessed June 1, 2012
Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia.  Arch Neurol. 2011;68(2):214-220
PubMed   |  Link to Article

Figures

Tables

Table Graphic Jump LocationTable. Prevalence (%) and Number (in Millions) of Adults by Hearing and Vision Impairment Status: National Health and Examination Surveys, 1999 Through 2006a

References

Caban AJ, Lee DJ, Gómez-Marín O, Lam BL, Zheng DD. Prevalence of concurrent hearing and visual impairment in US adults: the National Health Interview Survey, 1997-2002.  Am J Public Health. 2005;95(11):1940-1942
PubMed   |  Link to Article
Smith SL, Bennett LW, Wilson RH. Prevalence and characteristics of dual sensory impairment (hearing and vision) in a veteran population.  J Rehabil Res Dev. 2008;45(4):597-609
PubMed   |  Link to Article
Harada S, Nishiwaki Y, Michikawa T,  et al.  Gender difference in the relationships between vision and hearing impairments and negative well-being.  Prev Med. 2008;47(4):433-437
PubMed   |  Link to Article
Centers for Disease Control and Prevention (CDC).  National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: US Dept of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhanes.html. Accessed June 1, 2012
World Health Organization (WHO) Prevention of Blindness and Deafness Program.  Prevention of deafness and hearing impaired grades of hearing impairment. http://www.who.int/pbd/deafness/hearing_impairment_grades/en/index.html. Accessed June 1, 2012
Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia.  Arch Neurol. 2011;68(2):214-220
PubMed   |  Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 6

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
Visual Acuity

The Rational Clinical Examination
Visual Impairment