Adverse health consequences of undiagnosed hearing loss at middle age: A prospective cohort study with the UK Biobank

Shishi Xu, Can Hou, Xin Han, Yao Hu, Huazhen Yang, Yanan Shang, Wenwen Chen, Yu Zeng, Zhiye Ying, Yajing Sun, Yuanyuan Qu, Yu Lu, Fang Fang, Unnur A. Valdimarsdóttir, Huan Song*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Hearing impairment is common in the middle-aged population but remains largely undiagnosed and untreated. The knowledge about to what extent and how hearing impairment matters for health is currently lacking. Thus, we aimed to comprehensively examine the adverse health consequences as well as the comorbidity patterns of undiagnosed hearing loss. Study design: Based on the prospective cohort of the UK Biobank, we included 14,620 individuals (median age 61 years) with audiometry-determined (i.e., speech-in-noise test) objective hearing loss and 38,479 individuals with subjective hearing loss (i.e., tested negative but with self-reported hearing problems; median age 58 years) at recruitment (2006–2010), together with 29,240 and 38,479 matched unexposed individuals respectively. Main outcome measures: Cox regression was used to determine the associations of both hearing-loss exposures with the risk of 499 medical conditions and 14 cause-specific deaths, adjusting for ethnicity, annual household income, smoking and alcohol intake, exposure to working noise, and BMI. Comorbidity patterns following both exposures were visualized by comorbidity modules (i.e., sets of connected diseases) identified in the comorbidity network analyses. Results: During a median follow-up of 9 years, 28 medical conditions and mortality related to nervous system disease showed significant associations with prior objective hearing loss. Subsequently, the comorbidity network identified four comorbidity modules (i.e., neurodegenerative, respiratory, psychiatric, and cardiometabolic diseases), with the most pronounced association noted for the module related to neurodegenerative diseases (meta-hazard ratio [HR] = 2.00, 95%confidence interval [CI] 1.67–2.39). For subjective hearing loss, we found 57 associated medical conditions, which were partitioned into four modules (i.e., diseases related to the digestive, psychiatric, inflammatory, and cardiometabolic systems), with meta-HRs varying from 1.17 to 1.25. Conclusions: Undiagnosed hearing loss captured by screening could identify individuals with at greater risk of multiple adverse health consequences, highlighting the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention.

Original languageEnglish
Pages (from-to)30-38
Number of pages9
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant no. ZYYC21005 to HS) and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (grant no. Z20201013 to HS).

Funding Information:
This research has been conducted using the UK Biobank Resource under Application 54803. This work uses data provided by patients and collected by the NHS as part of their care and support. This research used data assets made available by National Safe Haven as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation. We thank the team members involved in West China Biomedical Big Data Center for their support.

Publisher Copyright:
© 2023 The Author(s)

Other keywords

  • Comorbidity network
  • Neurodegenerative disease
  • Self-reported hearing problem
  • Speech-in-noise test
  • Undiagnosed hearing loss
  • Cardiovascular Diseases
  • Prospective Studies
  • Humans
  • Middle Aged
  • Biological Specimen Banks
  • Hearing Loss/diagnosis
  • United Kingdom/epidemiology


Dive into the research topics of 'Adverse health consequences of undiagnosed hearing loss at middle age: A prospective cohort study with the UK Biobank'. Together they form a unique fingerprint.

Cite this