Hearing Impairment, Household Composition, Marital Status, and Mortality Among U.S. Adults

Divorce and physical health: A three-level meta-analysis

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

The protective effect of social support on all-cause and cardio-cerebrovascular mortality among middle-aged and older adults in the US

The relationship between social support and mortality, especially cardio-cerebrovascular mortality, still has some limitations in the assessment of social support, sample selection bias, and short follow-up time. We used the data from 2005 to 2008 National Health and Nutrition Examination Survey to examine this relationship. The study analyzed a total of 6776 participants, divided into Group 1, Group 2, and Group 3 according to the social support score (0-1; 2-3; 4-5). Multivariable adjusted COX regression analyses of our study showed that Group 3 and Group 2 had a reduced risk of all-cause and cardio-cerebrovascular mortality (Group 3 vs 1, HR: 0.55, P < 0.001; HR: 0.4, P < 0.001; Group 2 vs 1, HR: 0.77, P = 0.017; HR: 0.58, P = 0.014) compared with Group 1. The same results were observed after excluding those who died in a relatively short time. Additionally, having more close friends, being married or living as married, and enough attending religious services were significantly related to a lower risk of mortality after adjustment. In brief, adequate social support is beneficial in reducing the risk of all-cause mortality and cardio-cerebrovascular mortality in middle-aged and older adults, especially in terms of attending religious services frequency, the number of close friends, and marital status.

Hearing Impairment With Cognitive Decline Increases All-Cause Mortality Risk in Chinese Adults Aged 65 Years or Older: A Population-Based Longitudinal Study

Background

Hearing impairment (HI), a highly prevalent sensory impairment affecting older adults, is a risk factor for cognitive decline. However, few studies examined the association between HI and all-cause mortality, and the role of different cognitive states on this relationship in Chinese older adults is poorly understood.

Methods

A total of 10,744 Chinese older adults aged 65 years or older were included in the 2011/2012 and 2014 cohorts from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with the longest follow-up period lasting for up to 8 years. The presence of HI was identified by using a dichotomized metric of self-reported hearing status. All-cause mortality data were ascertained from interviews with family members or relatives of the participants. Cognitive function was evaluated by employing the modified Mini-Mental State Examination (MMSE), which consisted of seven subdomains (orientation, naming foods, registration, attention and calculation, copy figure, delayed recall, and speech and language). Kaplan–Meier survival curves were constructed to evaluate the different hearing states on overall survival. The risk of mortality over the follow-up period was estimated by using Cox proportional hazard ratios (HRs) models.

Results

A conspicuous probability was revealed in the survival relationship between hearing status and all-cause mortality for the total population (p < 0.001). Participants with HI had a higher risk of all-cause mortality (HR = 2.29, 95% CI: 2.16, 2.42), as compared with their counterparts without HI. The association was robust upon fully adjustment for potential confounders (HR = 1.07, 95% CI: 1.00, 1.14). Compared to HI participants with no cognitive impairment, HI patients with cognitive impairment had a higher mortality risk (HR = 2.31, 95% CI: 2.13, 2.51). Impairment in the subdomains of cognitive function were independently associated with elevated mortality risk in the participants with HI, with an HR ranging from 1.28 (copy figure) to 1.46 (speech and language).

Conclusions

Cognitive decline was common in individuals with HI, and those with HI and cognitive impairment further increased mortality risk. Our findings prompt a call for actions to improve the hearing status and cognitive function of older people to minimize health risks and improve longevity.

Associations of Hearing Loss and Dual Sensory Loss With Mortality: A Systematic Review, Meta-analysis, and Meta-regression of 26 Observational Studies With 1 213 756 Participants

IMPORTANCE

Hearing loss (HL) and dual sensory loss (DSL) are prevalent, disabling, and associated with numerous age-related health conditions, including dementia and frailty. To date, no evidence-based summary of their mortality risk is available.

OBJECTIVE

To clarify the epidemiological associations between HL/DSL and mortality.

DATA SOURCES

PubMed, Embase, and Cochrane Library, from inception until June 18, 2021.

STUDY SELECTION

Two blinded reviewers selected observational or interventional studies, published as full-length English articles in peer-reviewed journals, that reported the presence or severity of HL or DSL (ie, comorbid HL and vision loss), whether objectively measured or self-reported, in association with any mortality estimate, among adults 18 years and older.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and evaluated study bias using the Newcastle-Ottawa Scale, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and a PROSPERO-registered protocol. The analysis pooled maximally adjusted estimates using mixed-effects models, measured heterogeneity using I2, investigated sources of heterogeneity using meta-regression and subgroup meta-analyses, examined and adjusted for publication bias, performed influence and cumulative meta-analyses, and assessed evidence quality using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

MAIN OUTCOMES AND MEASURES

Hazard ratios (HRs) for all-cause, cardiovascular, or other mortality estimates.

RESULTS

This review included 14 retrospective and 12 prospective observational studies (1 213 756 participants) from 3220 records. Risk of bias was low to moderate; exclusion of 3 high-risk studies did not alter conclusions. Hearing loss was associated with excess all-cause mortality (HR, 1.13; 95% CI, 1.07-1.19; I2 = 77%; n = 21; 95% prediction interval [PI], 0.93-1.37) and cardiovascular mortality (HR, 1.28; 95% CI, 1.10-1.50; I2 = 60%; n = 6; 95% PI, 0.84-1.96), while DSL was associated with larger excess risks (all-cause: HR, 1.40; 95% CI, 1.30-1.51; I2 = 34%; n = 10; 95% PI, 1.18-1.66; cardiovascular: HR, 1.86; 95% CI, 1.31-2.65; I2 = 0%; n = 2), after adjustment for demographics and comorbidities. Prespecified meta-regression sufficiently explained heterogeneity, with longer follow-up duration weakening the pooled association, leaving low (29%) residual heterogeneity. Meta-regression among audiometric studies showed a dose-response association (doubling of HR per 30-dB increase in HL). Self-reported and audiometric effect sizes were similar, with lower heterogeneity in the latter. Associations were robust to trim-and-fill adjustment for publication bias and single-study influence and cumulative meta-analyses. Associations with accident/injury, cancer, and stroke mortality were inconclusive, with only 1 to 3 studies. Overall evidence quality was moderate.

CONCLUSIONS AND RELEVANCE

In this systematic review and meta-analysis, HL and DSL were associated with excess all-cause and cardiovascular mortality. Physicians caring for patients with HL should consider its relevance to general health and longevity.

Hearing Loss and Associated Factors Among Noise-Exposed Workers in Palm Oil Mills

Introduction

Almost 90% of the reported occupational diseases in Sabah, Malaysian Borneo were due to hearing loss. The manufacturing industry was the main contributor to this problem. This study aims to identify the prevalence and associated factors for hearing loss among workers in the palm oil manufacturing industry in Sabah.

Material and Methods

A cross-sectional study was done among 312 respondents from five palm oil mills in Sabah from January to April 2019. Audiometric tests, validated questionnaires and sound level meters were used. Chi-square test and independent t-test were conducted to determine the associated factors for hearing loss.

Results

75% (n = 234) of the respondents were diagnosed with hearing loss. Most of them were male (96.2%) with a mean age of 44.4 (SD 9.8) years, mean duration of employment of 16.2 (SD 9.7) years and mean noise exposure of 96.1 (SD 4.8) dB(A). The significant factors associated with hearing loss were older age (p = 0.001), married (p = 0.001), blue-collar jobs (p = 0.003), smoking (p = 0.001), works with noisy machinery (p = 0.005), lower level of noise exposed (p = 0.015), longer duration of employment (p = 0.001), and longer overtime hours per week (p = 0.001).

Conclusion

The prevalence of hearing loss among workers in the noise-exposed palm oil industries was high. Annual audiometry testing and job rotation from noise-exposed workstations were recommended. A smoking cessation program may help but reduction of noise from the source by engineering control is still the best method.