Investigating ethnic inequalities in hearing health in UK adults

Abstract

Ethnicity data in the UK are generally collected according to the categories of ethnicity found in the UK Census. The term “ethnic minority group” is often taken to refer to census groups other than White British. Ethnic inequalities can be defined as social, material and health disadvantage experienced by people from ethnic minority groups. Prior research has established the existence of ethnic inequalities in hearing health and hearing aid use in the UK. Levels of ‘poor’ or ‘insufficient’ hearing are higher among people from Bangladeshi, Black African, Pakistani, Black Other, and Asian Other ethnic groups. Yet levels of hearing aid use are lower among Black African, Black Caribbean and Indian cohorts. This thesis further investigates these inequalities. The thesis comprises three studies. The first is a scoping review of the data available to study ethnic inequalities in hearing health and hearing aid use. The study concludes that there are little available data in the UK that would be suitable for research of this nature. The second and third studies use the best dataset identified in the scoping review, the UK Biobank. The second study investigates ethnic inequalities in hearing health, and finds that the hearing test used in the UK Biobank, which involves listening to sets of numbers read out in English, is biased against nonnative speakers of English, having a dependency on language proficiency that the self-reported measures of hearing do not. Ethnic inequalities remain after correcting for language proficiency, and inequalities exist even when considering only the UK-born ethnic minority population. The third study examines levels of hearing aid use across ethnic groups in England and Wales. Using a model correcting for an extended range of socioeconomic measures, the study finds that people from certain ethnic minority groups are less likely to use a hearing aid than the white British or Irish population. These ethnic inequalities held regardless of whether participants were born in the UK, used private healthcare, and whether participants were aware of their hearing loss. This suggests barriers to services that are not due to unfamiliarity with the UK National Health Service. The study also finds ethnic inequalities in levels of self-reported hearing difficulty. The resulting picture of ethnic inequalities in UK hearing health is that people from ethnic minority groups are more likely to have poorer hearing, but are less likely to report having hearing difficulties, and less likely to use a hearing aid. The thesis concludes with a series of recommendations to NHS commissioners, researchers, and the government.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Nicholas Shryane (Supervisor), Dharmi Kapadia (Supervisor) & Piers Dawes (Supervisor)