08 Nov Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions
MedicalResearch.com Interview with:
Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study?
Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.
MedicalResearch.com: What are the main findings?
Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.
Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss.
MedicalResearch.com: What should readers take away from your report?
Response: I think this lends further evidence to the importance of hearing loss as a public health concern. Most of the time, we think of hearing loss as this benign aspect of aging but research is emerging that it contributes to poorer health (dementia and falls) and healthcare (cost, utilization).
Specific to the cost and utilization, the mechanisms for hearing loss contributing to these outcomes is likely a combination of increased comorbidities (e.g. falls, dementia, depression, etc.) and poor patient-provider communication. Hearing loss may limit patients’ ability to understand their providers and hinder their ability to participate in their own healthcare. This could lead to poor treatment adherence which is known to be associated with increased cost and utilization.
At the current time, hearing aids are the gold standard treatment for hearing loss yet less than 20% of persons with hearing loss have hearing aids. Although we don’t measure how hearing aids impact this relationship (i.e. do hearing aids prevent higher costs) in this study, I think comprehensive strategies to address hearing loss are needed. (There has been an increase in the prevalence of hearing aid diversity, for example TV ears, specifically created for watching TV mark a growing trend for specialist equipment.)
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Firstly, it is necessary to confirm these results using objectively measured hearing data. Some of this has already been done in NHANES data (hospitalizations) but much is lacking. Secondly, extremely important in this research is measuring how hearing aids impact this relationship. It is possible that hearing aid use may mitigate some comorbidities such as depression and could help overcome patient-provider communication issues. To that extent, we’ve begun assessing the impact of basic hearing amplification on patient-provider communication at Johns Hopkins.
Reed NS, Altan A, Deal JA, et al. Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years. JAMA Otolaryngol Head Neck Surg. Published online November 08, 2018. doi:10.1001/jamaoto.2018.2875
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