Introduction
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RQ-1: What is the association between baseline hearing ability and falls due to balance problems 10 years later among adults aged 40 years and older at baseline?
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RQ-2: (a) What is the association between 10-year change in hearing ability and falls at 10 years due to balance problems? (b) Does this association differ among adults with and without dizziness complaints?
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RQ-3: Is there a cross-sectional association between hearing aid use and falls among those with hearing impairment?
Materials and methods
Study design and setting
Measures
Dependent variables
Independent variables
Confounders and effect modifiers
Sample population
Statistical analyses
Results
Sample characteristics
RQ-1, 2a, 2b | RQ-3 | ||||
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T0-T2 (N = 496) | T1-T3 (N = 284) | T2 (N = 363) | T3 (N = 147) | ||
Age (years), M ± SD (range) | 53.0 ± 6.6 (40–71) | 55.2 ± 7.8 (40–69) | 53.6 ± 6.7 (40–69) | 57.6 ± 7.5 (40–71) | |
Sex, n (%) | Female | 280 (56.6) | 164 (58.0) | 220 (60.6) | 90 (61.2) |
Living situation, n (%) | Alone | 120 (24.2) | 72 (25.4) | 78 (21.5) | 36 (24.5) |
Level of education, n (%) | Low or medium | 191 (38.6) | 106 (37.3) | 150 (41.3) | 54 (36.7) |
Baseline SRTn, M ± SD | -5.57 ± 2.61 | -5.40 ± 2.66 | -2.19 ± 3.08 | -1.27 ± 3.51 | |
Baseline SRTn, n (%) | -10.6 to -7.4 dB SNR | 135 (27.2) | 69 (24.3) | - | - |
-7.2 to -6.2 dB SNR | 116 (23.4) | 76 (26.8) | - | - | |
-6.0 to -4.2 dB SNR | 124 (25.0) | 66 (23.2) | - | - | |
-4.0 to 1.9 dB SNR | 121 (24.4) | 73 (25.7) | - | - | |
ΔSRTn, M ± SD | 0.62 (2.63) | 0.58 (2.61) | - | - | |
ΔSRTn, n (%) | -8.8 to -1.0 dB SNR | 133 (26.8) | 86 (30.3) | - | - |
-1.0 to 0.4 dB SNR | 122 (24.6) | 67 (23.6) | - | - | |
0.4 to 2.2 dB SNR | 125 (25.2) | 71 (25.0) | - | - | |
2.2 to 8.6 dB SNR | 116 (23.4) | 60 (21.1) | - | - | |
Hearing aid(s), n (%) | Yes | 148 (29.8) | 137 (59.6) | 227 (62.5) | 110 (74.8) |
Hearing aid use, n (%) | No use or < 2 years | - | - | 144 (39.7) | 39 (26.5) |
≥ 2 years | - | - | 219 (60.3) | 108 (73.5) | |
Loneliness, n (%) | Moderate to severe | 248 (50.1) | 134 (47.2) | 186 (51.2) | 67 (45.6) |
Depression, n (%) | Moderate to severe | 86 (17.3) | 45 (15.8) | 67 (18.5) | 21 (15.6) |
Incident falls, n (%) | 0 | 433 (87.3) | 253 (89.1) | 303 (83.5) | 120 (81.6) |
1 | 63 (12.7) | 31 (10.9) | 60 (16.5) | 27 (18.4) | |
Recurrent falls, n (%) | 0 or 1 | 465 (93.8) | 263 (92.6) | 336 (92.6) | 127 (86.4) |
≥ 2 | 31 (6.3) | 21 (7.4) | 27 (7.4) | 20 (13.6) | |
Dizziness complaints, n (%) | Yes | 107 (21.6) | 69 (24.3) | 96 (26.4) | 45 (30.6) |
History of dizziness with falls, n (%) | 55 (11.1) | 7 (2.5) | 47 (12.9) | 6 (4.1) | |
Chronic health conditions, n (%) | Severe heart disease | 29 (5.8) | 8 (2.8) | 21 (5.8) | 4 (2.7) |
Hypertension | 121 (24.4) | 73 (25.7) | 89 (24.5) | 35 (23.8) | |
Diabetes | 30 (6.0) | 12 (4.2) | 25 (6.9) | 10 (6.8) | |
Chronic back pain | 87 (17.5) | 40 (14.1) | 75 (20.7) | 18 (12.2) | |
Osteoarthritis of knees and hips | 177 (35.7) | 72 (25.4) | 148 (40.8) | 36 (24.5) | |
Rheumatoid arthritis | 37 (7.5) | 14 (4.9) | 39 (10.7) | 2 (1.4) | |
Other chronic arthritis | 29 (5.8) | 16 (5.6) | 30 (8.3) | 7 (4.8) | |
Other nervous system disorders | 10 (2.0) | 2 (0.7) | - | - | |
Malignant condition or cancer | 22 (4.4) | 17 (6.0) | 16 (4.4) | 7 (4.8) | |
Injury due to accident | 47 (9.5) | 16 (5.6) | 41 (11.3) | 8 (5.4) | |
Missing | 1 (0.2) | 1 (0.3) | 0 | 0 | |
Other health conditions, n (%) | Near- or farsightedness | 117 (23.6) | 51 (18.0) | 112 (29.7) | 42 (28.6) |
Missing | 0 | 0 | 4 | 0 | |
Obesity | 70 (14.1) | 38 (13.4) | 66 (18.2) | 21 (14.3) | |
Missing | 3 (0.6) | 3 (1.0) | 0 | 2 (1.3) | |
Mobility issues, n (%) | 113 (22.8) | 51 (18.0) | 87 (24.0) | 25 (17.0) | |
Difficulty performing usual activities, n (%) | 126 (25.4) | 80 (28.2) | 103 (28.4) | 40 (27.2) | |
Missing | 1 (0.2) | 1 (0.3) | 0 | 0 | |
Alcohol, n (%) | > 2 glasses per drinking occasion | 199 (40.1) | 117 (41.2) | 158 (43.5) | 67 (46.5) |
Missing | 3 (0.6) | 9 (3.2) | 3 (0.9) | 5 (2.5) |
RQ-1: Association between baseline SRTn and falls 10 years later
Incident falls (1) | Recurrent falls (≥ 2) | |||||
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1 Fall/ 0 fallse | OR [95% CI] | p | ≥ 2 Falls/ < 2 fallse | OR [95% CI] | p | |
Model 1 | ||||||
Baseline SRTn (dB SNR) | - | 0.003**a | - | 0.030*a | ||
-10.6 to -7.4 (reference) | 22/168 | 1 | 6/198 | 1 | ||
-7.2 to -6.2 | 20/198 | 1.00 [0.55, 1.83] | 0.99 | 14/178 | 2.61 [1.14, 5.94] | 0.023* |
-6.0 to -4.2 | 26/170 | 0.94 [0.50, 1.79] | 0.86 | 12/178 | 2.05 [0.90, 4.67] | 0.087 |
-4.0 to 1.9 | 26/150 | 2.27 [1.29, 3.99] | 0.004** | 20/174 | 3.49 [1.52, 8.00] | 0.003* |
Model 2b | ||||||
Baseline SRTn (dB SNR) | - | - | - | - | 0.12a | |
10.6 to -7.4 (reference) | - | - | - | 6/197 | 1 | |
-7.2 to -6.2 | - | - | - | 14/178 | 2.15 [0.90, 5.13] | 0.086 |
-6.0 to -4.2 | - | - | - | 12/178 | 1.79 [0.64, 4.35] | 0.20 |
-4.0 to 1.9 | - | - | - | 20/174 | 2.91 [1.21, 7.02] | 0.017* |
Stratified model | ||||||
BMI < 30c | - | 0.32a | - | - | - | |
Baseline SRTn (dB SNR) | ||||||
10.6 to -7.4 (reference) | 18/163 | 1 | - | - | - | |
-7.2 to -6.2 | 17/149 | 0.96 [0.50, 1.86] | 0.91 | - | - | - |
-6.0 to -4.2 | 16/144 | 0.86 [0.42, 1.75] | 0.68 | - | - | - |
-4.0 to 1.9 | 25/136 | 1.50 [0.80, 2.80] | 0.21 | - | - | - |
BMI ≥ 30d | - | 0.002**a | - | - | - | |
Baseline SRTn (dB SNR) | ||||||
10.6 to -7.4 (reference) | 1/21 | 1 | - | - | - | |
-7.2 to -6.2 | 1/25 | 0.89 [0.07, 12.1] | 0.93 | - | - | - |
-6.0 to -4.2 | 3/25 | 2.39 [0.27, 20.9] | 0.43 | - | - | - |
-4.0 to 1.9 | 13/19 | 14.7 [2.12, 103] | 0.007** | - | - | - |
RQ-2a: Association between 10-year change in SRTn and falls
Incident falls (1) | Recurrent falls (≥ 2) | |||||
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1 Fall/ 0 falls b | OR [95% CI] | p | ≥ 2 Falls/ < 2 fallsb | OR [95% CI] | p | |
Model 1 | ||||||
ΔSRTn (dB SNR) | - | 0.32a | - | 0.28a | ||
-8.8 to -1.0 (reference) | 22/168 | 1 | 10/180 | 1 | ||
-1.0 to 0.4 | 20/198 | 0.77 [0.41, 1.46] | 0.43 | 11/207 | 0.89 [0.38, 2.10] | 0.80 |
0.4 to 2.2 | 26/170 | 1.09 [0.60, 1.98] | 0.77 | 16/180 | 1.35 [0.65, 2.80] | 0.42 |
2.2 to 8.6 | 26/150 | 1.36 [0.75, 2.46] | 0.31 | 15/161 | 1.70 [0.84, 3.42] | 0.14 |
Model 2 | ||||||
ΔSRTn (dB SNR) | - | 0.49a | - | 0.10a | ||
-8.8 to -1.0 (reference) | 22/167 | 1 | 10/180 | 1 | ||
-1.0 to 0.4 | 20/197 | 1.04 [0.51, 2.11] | 0.52 | 11/207 | 1.17 [0.45, 3.05] | 0.75 |
0.4 to 2.2 | 26/170 | 1.33 [0.68, 2.59] | 0.40 | 16/180 | 1.94 [0.85, 4.46] | 0.12 |
2.2 to 8.6 | 26/150 | 1.49 [0.80, 2.79] | 0.21 | 15/161 | 2.20 [1.03, 4.71] | 0.042* |
RQ-2b: Role of dizziness in the association between 10-year change in SRTn and falls
RQ-3: Association between hearing aid use and falls
Incident falls (1) | Recurrent falls (≥ 2) | ||||||
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OR [95% CI] | p | OR [95% CI] | p | ||||
Model 1 | 1 Fall/ 0 fallsa | ≥ 2 Falls/ < 2 fallsa | |||||
Hearing aid use | No use or < 2 years (reference) | 27/156 | 1 | 15/168 | 1 | ||
≥ 2 years | 60/267 | 1.20 [0.71, 2.01] | 0.50 | 32/295 | 0.86 [0.39, 1.89] | 0.71 | |
Stratified model | |||||||
Male | |||||||
Hearing aid use | No use or < 2 years (reference) | - | - | - | 8/60 | 1 | |
≥ 2 years | - | - | - | 9/123 | 0.46 [0.14, 1.55] | 0.21 | |
Female | |||||||
Hearing aid use | No use or < 2 years (reference) | - | - | - | 7/108 | 1 | |
≥ 2 years | - | - | - | 23/172 | 1.67 [0.94, 2.98] | 0.082 |