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American Journal of Epidemiology Advance Access published online on May 18, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwp097
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Tracking Population Health Based on Self-reported Impairments: Trends in the Prevalence of Hearing Loss in US Adults, 1976–2006

Nayu Ikeda, Christopher J. L. Murray and Joshua A. Salomon

Correspondence to Dr. Joshua A. Salomon, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: jsalomon{at}hsph.harvard.edu).

Received for publication December 8, 2008. Accepted for publication April 1, 2009.

Trends in the prevalence of hearing loss among US adults remain ambiguous because of variation across surveys in question wording and limited use of audiometric examinations. Pooling samples of participants aged 20–69 years in 4 nationally representative cross-sectional survey series conducted from 1976 to 2006 (N = 990,609), the authors performed logistic regression to quantify self-reporting biases compared with audiometric measurements. Statistically significant underreporting or overreporting of hearing loss was observed, with various patterns of bias across age groups and surveys. Substantial upward reporting biases appeared among young adults in the National Health and Nutrition Examination Survey since 1999 and in the National Health Interview Survey since 1997. Trends in age-standardized prevalence of bilateral hearing loss were estimated with corrections for self-reporting biases. Prevalence in men shifted from 9.6% (95% confidence interval (CI): 7.8, 11.8) in 1978 to 12.2% (95% CI: 10.1, 14.7) in 1993 and declined to 8.1% (95% CI: 7.0, 9.5) in 2000. In women, prevalence was relatively constant at approximately 6%–7% until the early 1990s and decreased from 7.0% (95% CI: 5.5, 9.1) in 1993 to 4.2% (95% CI: 3.4, 5.3) in 2000. Prevalence was stable in both sexes in the early 2000s. This approach to adjust for biases in self-reported impairments by using measured performance may be useful in various health domains.

adult; cross-sectional studies; health surveys; hearing loss; logistic models; prevalence; United States; validation studies

Abbreviations: CI, confidence interval; MEPS, Medical Expenditure Panel Survey; NHANES, National Health and Nutrition Examination Survey; NHIS, National Health Interview Survey; SIPP, Survey of Income and Program Participation


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