Incident Hearing Loss and Comorbidity A Longitudinal Administrative Claims Study
Incident Hearing Loss and Comorbidity A Longitudinal Administrative Claims Study
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DOI：
10.1001/jamaoto.2018.2876
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发表时间：
2019-01-01
影响因子：
7.8
通讯作者：
Altan, Aylin
中科院分区：
文献类型：
--
作者：
Deal, Jennifer A.;Reed, Nicholas S.;Altan, Aylin
重要性由于听力损失是高度流行和可治疗的，确定其与发病率的关系对预防疾病和维护成年听力损失患者的健康具有重大的公共卫生意义。目的调查50岁或以上成年人突发性听力损失诊断与医疗合并症之间的关系。一项倾向匹配的队列研究，使用来自不同地理位置的美国健康计划中的商业保险和Medicare Advantage成员的行政索赔数据。从2000年1月1日至2016年12月31日，对50岁或以上的成年人进行了2年（n = 154 414）、5年（n = 44 852）和10年（n = 4728）的观察。该研究是概念化的，数据分析于2016年9月至2017年11月之间。暴露事件性听力损失索赔定义为连续2年内2次听力损失索赔，无听力设备使用证据，不包括突发性听力损失或继发于医疗条件的听力损失索赔。主要结局和指标痴呆，抑郁，意外福尔斯，结果队列匹配后，48%的参与者为女性（n = 74464），61%为白色（ri = 93442），31%（n = 48056）为Medicare Advantage保险人，平均（SD）年龄为64（10）岁。在多变量调整的改良泊松回归中，具有稳健的标准误，痴呆（5年时的相对风险，1.50; 95%CI，1.38-1.64）和抑郁症（5年时的相对风险，1.41; 95%CI，1.26-1.58）的相关性最强。听力损失患者的所有结局的绝对风险均高于无听力损失者，在10年时观察到所有结局的最大风险差异。听力损失的10年风险为每100人3.20人（95% CI，1.76-4.63）痴呆，3.57/100人（95% CI，1.67-5.47）为福尔斯，6.88/100人（95%CI，4.62-9.14）。结论和相关性在这项使用管理数据的大型观察性研究中，在一系列健康状况下，与无听力损失相比，未经治疗的听力损失与更高的发病率相关。未来的研究需要阐明这些相关性的机制，并确定听力损失的治疗是否可以降低合并症的风险。
IMPORTANCE Because hearing loss is highly prevalent and treatable, determining its association with morbidity has major public health implications for disease prevention and the maintenance of health in adults with hearing loss.OBJECTIVE To investigate the association between the diagnosis of incident hearing loss and medical comorbidities in adults 50 years or older.DESIGN, SETTING, AND PARTICIPANTS Retrospective, propensity-matched cohort study using administrative claims data from commercially insured and Medicare Advantage members in a geographically diverse US health plan. Adults 50 years or older with claims for services rendered from January 1, 2000, to December 31, 2016, were observed for 2 (n = 154 414), 5 (n = 44 852), and 10 (n = 4728) years. This research was conceptualized and data were analyzed between September 2016 and November 2017.EXPOSURES A claim for incident hearing loss is defined as 2 claims for hearing loss within 2 consecutive years without evidence of hearing device use, excluding claims for sudden hearing loss or hearing loss secondary to medical conditions.MAIN OUTCOMES AND MEASURES Incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke.RESULTS After cohort matching, 48% of participants were women (n = 74 464), 61% were white (ri = 93 442), and 31% (n = 48 056) were Medicare Advantage insured, with a mean (SD) age of 64 (10) years. In a multivariate-adjusted modified Poisson regression with robust standard errors, relative associations were strongest for dementia (relative risk at 5 years, 1.50; 95% CI, 1.38-1.64) and depression (relative risk at 5 years, 1.41; 95% CI, 1.26-1.58). The absolute risk of all outcomes was greater in persons with hearing loss than in those without hearing loss at all times, with the greatest risk difference observed at 10 years for all outcomes. The 10-year risk attributable to hearing loss was 3.20 per 100 persons (95% CI, 1.76-4.63) for dementia, 3.57 per 100 persons (95% CI, 1.67-5.47) for falls, and 6.88 per 100 persons (95% CI, 4.62-9.14) for depression.CONCLUSIONS AND RELEVANCE In this large observational study using administrative daims data, incident untreated hearing loss was associated with greater incident morbidity than no hearing loss across a range of health conditions. Future studies are needed to elucidate the mechanisms underlying these associations and to determine if treatment for hearing loss could reduce the risk of comorbidity.