Comorbidities

Last update on Oct, 17, 2024

How Good Hearing Drives Good Health

What health plans should know about hearing and its connections to costly health conditions.

By: Carrie Meyer, Au.D., ABAC

Carrie Meyer, Au.D., ABAC

Director of Clinical Programs

The power of hearing health care runs deep

On the surface, a health plan hearing benefit improves access to hearing aids, which enable members to address their hearing loss and participate more fully in the world around them. But the power of hearing health care runs much deeper. Specifically, the use of hearing aids offers tremendous potential to help members achieve better overall health while significantly reducing costs for health plans.

A Hearing Loss Primer

3rd most common

Chronic health condition

Hearing loss is the third most common chronic health condition in U.S. adults, just behind arthritis and heart disease, and it’s more common than either diabetes or cancer. [1]

1 in 8 people

13% of the US population

One in eight people in the United States (13%, or 30 million) ages 12 or older has hearing loss in both ears, based on standard hearing examinations. [1]

Age

Age is the strongest predictor

Age is the strongest predictor of hearing loss among adults ages 20-69, with the greatest amount of hearing loss in the 60 to 69 age group. [1]

Disabling loss

55% for those 75+

About 5% of adults ages 45 to 54 have disabling hearing loss. The rate increases to 10% for adults ages 55 to 64; 22% for those 65 to 74; and 55% for those 75 and older. [1]

Primary treatment

Hearing aids

Hearing aids are the primary treatment option for most hearing loss, yet less than 35% of people who could benefit from hearing aids actually wear them. [2]

3rd most common

Chronic health condition

Hearing loss is the third most common chronic health condition in U.S. adults, just behind arthritis and heart disease, and it’s more common than either diabetes or cancer. [1]

1 in 8 people

13% of the US population

One in eight people in the United States (13%, or 30 million) ages 12 or older has hearing loss in both ears, based on standard hearing examinations. [1]

Age

Age is the strongest predictor

Age is the strongest predictor of hearing loss among adults ages 20-69, with the greatest amount of hearing loss in the 60 to 69 age group. [1]

Disabling loss

55% for those 75+

About 5% of adults ages 45 to 54 have disabling hearing loss. The rate increases to 10% for adults ages 55 to 64; 22% for those 65 to 74; and 55% for those 75 and older. [1]

Primary treatment

Hearing aids

Hearing aids are the primary treatment option for most hearing loss, yet less than 35% of people who could benefit from hearing aids actually wear them. [2]

Connection to Chronic Health Conditions

The complexity and small size of the human auditory system make it vulnerable to even subtle changes in overall health. Because the tiny inner ear has a delicate chemical makeup and a small blood supply, changes in body chemistry and blood flow have an outsized impact on the ears and hearing. Certain chronic health conditions, including those discussed below, can be especially devastating to the ears and hearing.

Diabetes

By damaging the inner ear blood vessels and nerve endings, elevated blood sugar increases the risk for microvascular disease that causes nonreversible hearing loss, much in the same way that it leads to vision loss. Interestingly, hearing loss is more common than vision loss in people with diabetes; 54% of people with diabetes have some degree of hearing loss, compared to 21% who will develop diabetic retinopathy. In addition, among adults with prediabetes, the rate of hearing loss is 30% higher than those with normal blood sugar. This is why members with diabetes and prediabetes should undergo routine hearing exams in addition to regular eye exams. [3], [4], [5]

Hypertension

Nearly half of adult Americans have high blood pressure. Hypertension causes structural changes in the heart and blood vessels, which decrease blood flow and oxygen transport to the ear, ultimately damaging hair cells and hearing ability. In fact, hearing loss is 30% higher among adults with hypertension than those with normal blood pressure. The incidence of hearing loss worsens with age, as well as with the severity and duration of hypertension. In addition, tinnitus, commonly known as “ringing in the ears,” is more prevalent in adults with high blood pressure. [6], [7], [8] Patients with high blood pressure should be screened regularly for hearing loss.

Cardiovascular disease

Heart disease is the leading cause of death in people of most racial and ethnic groups in the United States, and it results in one death every 33 seconds. [8] Cardiovascular disease creates narrowing or blockages in the tiny capillaries that supply blood to the inner ear, damaging or destroying the hair cells needed for hearing. Not surprisingly, research has shown that hearing loss occurs 54% more often in people with heart disease, and 75% of heart failure patients experience hearing loss. [9] The impact of hearing loss due to cardiovascular disease can be reduced with regular hearing evaluations. [8], [9]

Bottom line: Hearing loss detection and intervention can be a valuable tool for diagnosing these chronic conditions in their earlier stages, when they are typically easier and less costly to manage.

Hearing Loss Comorbidities

Chronic health conditions such as diabetes, hypertension, and cardiovascular disease greatly increase the risk of hearing loss. Conversely, hearing loss is the primary manageable risk factor for the following serious health conditions:

Falls

Hearing loss is one of the leading risk factors for injury-causing falls. Even mild hearing loss, defined as less than 25 decibels (dB), increases the risk of falling by threefold. With every additional 10 dB of hearing loss, the risk increases by 1.4. [10], [11] While the connection between hearing, balance, and falls is complex, one theory points to a reduction in environmental cues and increased cognitive load due to hearing loss as primary factors.

Depression

Nearly 29% of U.S. adults report being diagnosed with depression during their lifetime. [12] Hearing loss significantly increases the risk of depression in adults. Specifically, individuals with moderate to severe hearing loss report nearly twice as much psychological distress and the use of antidepressant or anti-anxiety medications, compared to peers with normal hearing. [13] In addition, adults with hearing loss are 1.5 times more likely to seek mental health care. [14] The link between hearing loss and depression appears to be the increased difficulty of communicating and social isolation. [13]

Dementia

Hearing loss is one of the primary modifiable risk factors in the development of cognitive decline and dementia — a huge topic of concern as our large population of baby boomers continues to move into their senior years. Mild hearing loss doubles dementia risk; moderate hearing loss triples dementia risk; and those with severe hearing loss are five times more likely to develop dementia and related cognitive disorders. [15] One hypothesis points to a faster rate of brain atrophy due to reduced auditory stimulation. In fact, individuals with hearing loss lose an additional cubic centimeter of brain tissue each year, compared to those with normal hearing. [16]

Untreated Hearing Loss Impacts

As shown above, untreated hearing loss has a significant impact on the overall health and quality of life for health plan members. On one hand, we’re seeing a greater incidence of hearing loss due to a variety of common chronic health conditions, including diabetes, hypertension, and cardiovascular disease. On the other hand, research has clearly shown untreated hearing loss to be a significant risk factor for injury-causing falls, depression, and dementia.

Untreated hearing loss also drives up health care utilization and costs. According to a study published in JAMA Head and Neck Surgery [17], untreated hearing loss in older adults leads to:

46% higher health care costs over 10 years — which translates to about $22,434 per person
50% more hospital stays
A 44% higher risk of being readmitted to the hospital within 30 days of discharge
A 17% increased likelihood of emergency department visits
52% more outpatient visits

In summary, untreated hearing loss costs health plans millions of dollars every year. [18]

How Hearing Aids Can Make a Difference

Fortunately, hearing loss is a manageable risk factor, and hearing aids provide the primary treatment option for almost all cases of hearing loss. Furthermore, recent research shows the impact of consistent hearing aid use in reducing the risk of injury-causing falls, depression, and dementia. Following are specific research findings.

Hearing aid use reduced the risk of falls by 50%. Notably, individuals who wore their hearing aids for four or more hours per day experienced the greatest reduction in fall risk. [19] This is why Amplifon Hearing Health Care has piloted a smartphone app and remote coaching program to encourage fulltime use of hearing aids. In an ongoing study on Amplifon members, results show 11% improvement in communication, quality of life, and connection with others among users with Amplifon benefits vs. those without. [20]
In an observational study involving both hearing aids and cochlear implants, wearers experienced a substantial improvement in depressive symptoms in as little as six months following the fitting of these devices. [21]
The ongoing ACHIEVE study conducted by Johns Hopkins University [22] compared hearing aid use in “at-risk groups” (participants with chronic health conditions, including diabetes, hypertension, and heart disease) to that of healthy older adults. Half the participants were fit with hearing aids; the other half received health coaching. At the end of three years, the study found that for healthy older adults, hearing aids had little impact on cognitive decline, while hearing aids reduced dementia risk by up to 48% in the at-risk group.

Barriers to Hearing Aid Adoption

The overwhelming evidence shows that hearing aids deliver significant positive impacts for health plan members with hearing loss, as well as for their health plans. Yet, as mentioned earlier, only about a third of adults who could benefit from hearing aids actually wear them.

Why is hearing aid adoption so low among U.S. adults?

One reason may be the lack of routine screenings for hearing loss. A hearing test that clearly demonstrated the need for hearing aids was the primary motivating factor for 59% of individuals surveyed for MarkeTrak 2022, an ongoing study of the hearing aid industry and hearing aid usage in U.S. adults for more than 30 years.

While health guidelines are provided for routine screenings for vision, hypertension, and diabetes, no clear-cut guidelines exist for hearing loss. Leading risk factors for hearing loss are aging and exposure to excessive noise, along with the chronic health conditions discussed above. Health plans could take a big step toward addressing hearing loss, improving member health, and reducing their costs simply by offering a routine hearing evaluation to at-risk populations.

Another reason people don’t address their hearing loss is the high cost of hearing aids. Yet 27% of individuals in the MarkeTrak 2022 survey said they would choose amplification if their health plan offered some coverage of hearing aids. Specifically, having insurance coverage was shown to be a more powerful factor in the adoption of hearing aids than the cost of the devices themselves.18 Even a minimal amount of coverage, such as providing hearing testing, could contribute to broader hearing aid adoption.

Amplifon Hearing Health Care is dedicated to tailoring a hearing benefit to each health plan with the goal of driving higher hearing aid adoption. This will ultimately lead to improved overall health and quality of life for members, along with lower costs and a stronger return on investment for health plans. Our financial modeling suggests that every 1% of increased utilization by a health plan with 100,000 lives would yield savings of nearly $7 million per year in medical spend.

Wrapping It Up: A Multitude of Positive Outcomes

Hearing aids are marvels of micro-technology that do so much more than amplify sound for people with hearing loss. For starters, hearing aids restore the ability to communicate with loved ones and friends. Other potential benefits include:

Returning individuals to the social activities that are important to them, preventing social isolation, loneliness, and negative health impacts
Reducing the risk of injury-causing falls by decreasing cognitive load and increasing environmental awareness
Lowering the risk of depression that can result from communication difficulties and social isolation
Decreasing the risk of dementia due to reduced auditory stimulation
Reducing health care utilization and its associated costs

Amplifon is ready to help health plans realize all of these goals through a high-quality hearing benefit, coupled with a comprehensive hearing aid formulary and a nationwide network of more than 7,000 credentialed hearing care locations, supported by 5,900+ fully contracted and NCQA-credentialed providers and more than 1,600 mobile provider locations. In turn, convenient access to affordable hearing health care not only enhances member satisfaction but also contributes to impressive Star Ratings and CAHPS scores, ultimately driving member retention.

At a time when an aging baby boomer generation is ratcheting up health care utilization and medical costs, the need for the right hearing benefit and the right hearing health care partner has never been greater.

Delivering more than 5-stars

At Amplifon's core is our passion for providing a white-glove experience and staying true to our mission of changing lives and improving whole-body health through the gift of better hearing. At the same time, we aim to elevate the success and ROI of our partners through constant innovation and proven cost-containment strategies.

Connect with our team

Our Expert

Carrie Meyer, Au.D., ABAC

Director of Clinical Programs

Dr. Meyer is a clinical audiologist with more than 30 years of experience in diagnostic audiology, as well as hearing aid evaluation, fitting, and verification. In her role as Director of Clinical Programs, Dr. Meyer works with providers, health plans, and members to achieve the best possible hearing health outcomes by improving clinical care pathways. Dr. Meyer is the Chair of the American Board of Audiology.

[1] Quick Statistics About Hearing, Balance, & Dizziness; March 4, 2024. National Institute on Deafness and Other Communication Disorders.

[2] Trends in Hearing Aid Ownership Among Older Adults in the United States From 2011 to 2018; Nicholas S. Reed, AuD; Emmanuel Garcia-Morales, PhD; Amber Willink, PhD; JAMA Intern Med. 2021;181(3):383-385

[3] National Diabetes Statistics Report, Centers for Disease Control; May 15, 2024

[4] Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Bainbridge KE, Hoffman HJ, Cowie CC. Ann Intern Med. 2008;149(1):1–10.

[5] Economic costs of Diabetes in the U.S. in 2022; Emily D Parker, Janice Lin, Troy Mahoney, Nwanneamaka Ume, Grace Yang, Robert A Gabbay, Nuha A ElSayed, Raveendhara R Bannuru; Diabetes Care. 2024 Jan 1;47(1):26-43

[6] Hypertension and the development of hearing loss. Toyama, K., Mogi, M.; Hypertension Research 45, 172–174 (2022).

[7] Health and Economic Benefits of High Blood Pressure Interventions; National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) July 12, 2024

[8] AHA Statistical Update: 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association; Circulation; Volume 149, Issue 8, 20 Feb 2024; e347-e913

[9] Relationship of cardiovascular disease risk and hearing loss in a clinical population. Baiduc, R.R., Sun, J.W., Berry, C.M. et al. Scientific Reports 13, 1642 (2023)

[10] Hearing loss and falls: A systematic review and meta-analysis; Nicole Tin-Lok Jiam, Carol Li, Yuri Agrawal; Laryngoscope. 2016 Nov;126(11):2587-2596

[11] The Medical Costs of Fatal Falls and Fall Injuries among Older Adults; Curtis Florence, Gwen Bergen, Adam Atherly, Elizabeth Burns, Judy Stevens, Cynthia Drake; Journal of the American Geriatrics Society; 2018 Apr; 66(4):693-698

[12] U.S. Depression Rates Reach New Highs; Witters, D., Wellbeing, May 17, 2023. https://news.gallup.com/poll/505745/depression-rates-reach-new-highs.aspx

[13] Association of Hearing Loss With Psychological Distress and Utilization of Mental Health Services Among Adults in the United States. Bigelow RT, Reed NS, Brewster KK, et al. JAMA Netw Open. 2020;3(7)

[14] The Economic Burden of Adults with Major Depressive Disorder in the United States (2019). Greenberg, P., Chitnis, A., Louie, D. et al. Advances in Therapy 40, 4460–4479

[15] Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US. Jennifer Manly, Richard Jones, Kenneth Langa; JAMA Neurology. 2022;79(12):1242-1249

[16] Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Gill Livingston, Jonathan Huntley, et al; The Lancet Commissions; Volume 396, Issue 10248, 413-446, August 08, 2020.

[17] Trends in Hearing Aid Ownership Among Older Adults in the United States From 2011 to 2018; Nicholas S. Reed, AuD; Emmanuel Garcia-Morales, PhD; Amber Willink, PhD; JAMA Intern Med. 2021;181(3):383-385.

[18] The Financing of Hearing Care: What We Can Learn from MarkeTrak 2022; Ian M. Windmill, PhD. Seminars in Hearing 2022; 43:339-347

[19] Consistent hearing aid use is associated with lower fall prevalence and risk in older adults with hearing loss; Laura Caompos, Allan Prochazka, Melinda Anderson, Alexander Kaiser, Carol Foster, Timothy Hullar; Journal of the American Geriatrics Society; Volume 71, Issue 10; October 2023; 3163-3171

[20] Amplifon Product Experience member study on health impact and hearing aid treatment effectiveness, results to be published by 2024.

[21] Association of Using Hearing Aids or Cochlear Implants With Changes in Depressive Symptoms in Older Adults; Janet Choi, Joshua Betz, et al; JAMA Otolaryngology, Head Neck Surgery; 2016 Jul 1; 142(7):652-7.

[22] Association of hearing impairment with brain volume changes in older adults. Lin FR, Ferrucci L, An Y, Goh JO, Doshi J, Metter EJ, Davatzikos C, Kraut MA, Resnick SM. Neuroimage. 2014 Apr 15;90:84-92. doi: 10.1016/j.neuroimage.2013.12.059. Epub 2014 Jan 9.