Healthcare Costs for Insured Older U.S. Adults with Hearing Loss

J Am Geriatr Soc. 2018 Aug;66(8):1546-1552. doi: 10.1111/jgs.15425. Epub 2018 May 24.


Objectives: To measure 18-month healthcare cost difference attributable to hearing loss (HL) in older adults.

Design: Matched cohort.

Setting: Retrospective analysis of administrative healthcare bills of insured older Americans.

Participants: Older U.S. adults with health insurance in 3 cohorts matched based on HL diagnosis using propensity score methods (N=904,750).

Measurements: Comparison groups were defined as those with and without HL diagnosis using International Classification of Diseases, Ninth Revision, diagnosis codes from billing records. Outcomes measured include 18-month total healthcare payments and healthcare payments broken down according to payment type (inpatient, outpatient, prescription, hearing services). Three comparison cohorts were examined for these outcomes: individuals covered by Medicare plus supplemental private insurance (Cohort 1, n=782,216), those covered only under Medicare (Cohort 2, n=105,296), and those within the Medicare sample that were dually eligible for Medicare and Medicaid coverage (Subcohort 3, n=17,238). The quality of the propensity score match was examined using standardized differences in means or proportions between all matched covariates, and cost outcomes were analyzed using multiple generalized linear regression models.

Results: Fully adjusted models showed significantly higher 18-month healthcare payments for individuals with a diagnosis of HL without indication of use of hearing services than in those without a HL diagnosis in the 3 samples (payment differences: $3,587 Cohort 1, $3,779 Cohort 2, $4,657 Subcohort 3; all p<.001). Payment differences were also found between individuals with HL and indications of hearing services and those without HL.

Conclusion: We observed more than 20% higher total healthcare payments over 18 months for a group of insured individuals with HL regardless of insurance type or hearing services use, indicating that negative health-related effects of HL may increase healthcare use unrelated to HL. Thus, clinical care to ameliorate HL may improve overall health.

Keywords: age-related hearing loss; healthcare costs; hearing loss; presbyacusis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Expenditures / statistics & numerical data*
  • Hearing Loss / economics*
  • Humans
  • Insurance, Health / statistics & numerical data*
  • Male
  • Medicare / statistics & numerical data*
  • Propensity Score
  • Retrospective Studies
  • United States