A retrospective cohort study on gout and hearing impairment in elderly based on the US Medicare claims data

Clinical Research 8 min 146

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Created On: 14/01/2020

A retrospective cohort study on gout and hearing impairment in elderly based on the US Medicare claims data

As per the data published by 2005–5006 NHANES (National Health and Nutritional Examination Survey), more than 2/3 of the US population aged 70 years or older found to have a hearing impairment.

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Key take away

The conclusion of the study states that gout is associated with a higher risk of hearing impairment in older adults.

Background

Hearing impairment is a recurrent problem in the ageing population. As per the data published by 2005–5006 NHANES (National Health and Nutritional Examination Survey), more than 2/3 of the US population aged 70 years or older found to have a hearing impairment. Another population-based study states that 46% of US adults aged 48–92 years suffer from hearing loss. A loss of hearing is associated with difficulty in self-reported communication, activities of daily living (ADL's) and instrumental ADL's difficulties, and a lower quality of life. Hearing loss has been found to be associated with a higher risk of incident dementia. Thus, hearing loss can be considered a significant health problem with long-term consequences, individual and societal burden.

A recent study using the NHANES data indicated that older age, white race, male sex, loud noise, diabetes and smoking are strongly related to hearing loss after multivariate adjustment. The previous research indicates that the inflammation, autophagic and oxidative stress can increase the risk of noise-induced or age-related hearing loss. Another condition which arises due to the older age, male sex, cardiovascular disease is gout which is the most prevalent inflammatory arthritis in adults. The primary symptoms of gout are hyperuricaemia and urate crystal formation associated with inflammation, oxidative stress and pathological processes implicated in the pathogenesis of hearing loss.

On the basis of the similarity in pathogenesis, it was hypothesised that gout in the elderly might increase the risk of new-onset hearing loss after, and the analysis was carried out after adjusting for known risk factors and that this association could vary depending upon age, sex and race.

Rationale behind research

Hearing loss was associated with increased oxidative stress, inflammation and autophagic stress. Some studies also suggest that gout can also act as a potential risk factor for hearing impairment. So, the present study was established to found an association between the pathogenesis of hearing loss and gout.

Objective

The present retrospective study was aimed to estimate whether the presence of gout increases the risk of hearing the loss in older adults or not.

Method

Study outcomes

Patient demographic characteristics were evaluated at baseline
Primary and secondary outcomes include evaluation of incident (new) hearing loss identified by the presence of at least two claims at least four weeks apart with an International Classification of Diseases, Ninth Revision, 389. xx, with no particular claim in the baseline 1-year observation period

Time Points: NA

Result

Outcomes

Baseline: There were no significant differences observed at baseline

Study outcomes:

There occurs a similarity in the HR of gout with hearing loss across age, race, gender subgroups but the interaction was statistically significant for age, gender and race (Fig 2.)

There was an association found between gout and hearing impairment in people with and without tobacco use, but the interaction was not significant statistically (Fig 2.)

Conclusion

The findings of the present study indicate an association of gout with a 44% higher risk of new hearing impairment. These findings were reported after adjusting the factors such as demographics, medical comorbidities and commonly used medications for cardiovascular disease and gout in adults aged 65 years or older. This was the first study which described the relation of gout with hearing loss in older adults. However, other studies of hyperuricaemia have shown similar results but are not directly comparable with the present study since the risk factors were not the same. Large study sample and adjustment of medication use for cardiovascular diseases and medical comorbidities makes this study data robust.

The study results, i.e., 32% to 44% increase in the risk of hearing loss associated with gout is valuable for clinical purposes. Hearing loss has a significant impact on physical, emotional and mental health with impaired quality of life. Hearing quality can be improved by the use of hearing aids; also they can be helpful to enhance the quality of life and protect against cognitive impairment.

Limitations

The study results were generalisable to adults aged 65 years or older
The algorithms were used for identifying people with hearing loss and gout, but there was no access to laboratory measures such as serum urate, or markers of inflammation (e.g., C reactive protein) or oxidative stress. Thus, it was not evaluated whether the association between gout and hearing loss is caused due to these factors

Clinical take-away

Early recognition of hearing loss associated with gout has a significant clinical implication. This study emphasizes on preventing the hearing loss, identification of the new risk factors like gout for early diagnosis and prevention of more severe hearing loss in elderly individuals. These findings may help to avoid treatment costs and disability associated with hearing loss.