Conceptual Model for Hearing Health Inequalities (HHI Model): A Tool for Prevention, Identification and Management of Age-related Hearing Loss

Abstract:
Purpose: The aim was to examine the mechanisms and to explain the associations between socioeconomic inequalities and hearing health in a life-course perspective.
Materials and Methods:A database search (PubMED, Scopus, PsychINFO) was conducted using the keywords “hearing AND inequalities”, “hearing AND disparities” and “hearing AND determinants” in Title/Abstract. Age group 45 and above was used as a search filter. After review of titles and abstracts of 160 articles that met these criteria, 77 articles were finally selected for inclusion in the integrative review.
Results:The impact of socioeconomic indicators (education, occupation, income) on hearing health across the life course is complicated, because each one affects the other.Besides, the hearing health inequalities accumulate, so as higher a person’s socioeconomic status during the life-course is, it affects his accumulative hearing health. In addition, there are modifiable determinants of age-related hearing loss, in several stages across the life span, thus a substantial proportion could be prevented or delayed.This analysis resulted in a conceptual model for “hearing health inequalities” (HHI Model), opening a new area in hearing loss research.
Conclusions: Tackling socioeconomic inequalities in hearing health during the life-course could significantly improve the hearing health of populations. The Hearing Health Inequalities Model (HHI Model) could be used as a tool for prevention, identification and management of hearing health inequalities and for policy formulation aimed at hearing loss risk reduction.This could make hearing loss a quite preventable disease and not an inevitable accompaniment of ageing.

Lay Abstract:
Hearing loss is a major global health challenge and the most prevalent untreated sensory disorder, as approximately 15% of the adult population has some degree of hearing loss and almost 7% of the world’s population –half a billion people- has disabling hearing loss (hearing threshold of 41 decibels or greater in the better ear). Across the UK, more than 11 million people suffer today from hearing loss, which translates to about one-in-six people in the UK. Hearing loss has a negative impact in people’s life, as it is associated with social isolation, depression, disability and low quality of life. Besides, the negative impact that has in healthy ageing is not negligible, as the one third of people above 65 live with disabling hearing loss. This makes the hearing loss the third most common chronic health condition among the older population, after high blood pressure and arthritis. However, there is strong evidence that a number of factors in its aetiology are modifiable. A notable example is that socioeconomic indicators like low educational attainment, unemployment and low income are positively associated with hearing loss prevalence. However, the mechanisms for these associations are not well defined in the literature. In its initial stages of this PhD project, the NIHR Doctoral Research Fellow Dialechti Tsimpida provided a theoretical framework to explain the relationship between socioeconomic inequalities and hearing health in a life-course perspective. This leaded to the formulation of a conceptual model for prevention, identification and management of “hearing health inequalities”, opening a new area in hearing loss research. The conclusion was that there are a lot modifiable determinants of age-related hearing loss, in several stages across the life span, thus a substantial proportion could be prevented or delayed. Tackling socioeconomic inequalities in hearing health during the life-course could significantly improve the hearing health of populations. This could make hearing loss a quite preventable disease and not an inevitable accompaniment of ageing.