Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years

Abstract

Importance: Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.

Objective: To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.

Design, setting, and participants: Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.

Exposures: Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.

Main outcomes and measures: Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.

Results: Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.

Conclusions and relevance: Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Reed reports grants from NIH KL2TR001077 during the conduct of the study and Scientific Advisory Board Member (nonfinancial relationship) to Clearwater Clinical. Dr Altan is an employee of OptumLabs. The AARP is a research partner and founding consumer advocate in OptumLabs and as a partner they fund 2 full-time equivalents to work on various projects in health care policy for the aging. Dr Altan’s work on this project was a part of that 2 full-time equivalent allotment. However, employment with OptumLabs was not dependent on that funding and the funding support work on multiple projects being conducted at OptumLabs. Dr Yeh reports a vendor client relationship with Hear USA that provides hearing services to AARP members. Dr Wallhagen is on the Board of the Hearing Loss Association of America in a noncompensated position and receives no payments and pay for all travel and other expenses. Dr Lin reports grants from National Institutes of Health and grants from Eleanor Schwartz Charitable Foundation during the conduct of the study; personal fees from Cochlear Ltd, personal fees from Amplifon, and personal fees from Boehringer Ingelheim outside the submitted work. No other disclosures were reported.

Figures

Figure 1.. Difference in Unadjusted Mean Patient-Paid, Plan-Paid, and Total Costs for Patients With Untreated Hearing Loss vs Patients With No Hearing Loss

Error bars represent the 95% CI. HPP indicates health plan–paid costs; OOP, out-of-pocket costs.

Figure 2.. Unadjusted Difference in 30-Day Readmissions for Participants With Untreated Hearing Loss vs Participants With No Hearing Loss

Bar graph represents the unadjusted difference in baseline incidence of 30-day readmissions in the 2- (risk difference [RD], 0.45; 95% CI, 0.31-0.58), 5- (RD, 0.82; 95% CI, 0.49-1.15), and 10- (RD, 0.45; 95% CI, 0.49-1.15) year cohorts with untreated and no hearing loss.