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Gout and hearing impairment in the elderly: a retrospective cohort study using the US Medicare claims data

Clinical Research 6 min 77

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Created On: 02/03/2020

Gout and hearing impairment in the elderly: a retrospective cohort study using the US Medicare claims data

Hearing impairment is a recurrent problem in the ageing population.

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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. According to data published by 2005–5006 National Health and Nutritional Examination Survey (NHANES), more than 2/3 of US adults aged between 70 years or older had 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. It can also be associated with a higher risk of stroke and 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. Animal studies have indicated that increased oxidative stress, inflammation and autophagic stress can potentiate noise induced or age-related hearing loss. Another condition that increases the risk factors similar to hearing loss (older age, male sex, cardiovascular disease) is gout, 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. It was hypothesised that gout in the elderly would be independently associated with higher risk of hearing loss after adjustment of known risk factors and can vary by important biological variables such as age, sex and race.

Rationale behind research:

Hearing loss was associated with increased oxidative stress, inflammation and autophagic stress. Some studies also suggests 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 aimed to evaluate whether gout is associated with a higher risk of hearing the loss in older adults.

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 after adjustment of demographics, medical comorbidities and commonly used medications for cardiovascular disease and gout in adults aged 65 years or older. The findings were robust across multiple sensitivity analysis. It is the first study to describe a relatedness 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. The strength of the study was the inclusion of a large representative study sample and adjustment for common medication use and medical comorbidities.

Our findings depicted 32%–44% increased hazards of hearing loss with the diagnosis of gout and the results should be interpreted in proper clinical context. Hearing loss has a significant impact on physical, emotional and mental health with impaired quality of life. Hearing aids not only improves the hearing quality but also protects against cognitive impairment, disability and improved quality of life.

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. Therefore, it was not assessed whether these mechanisms underlie the noted association between gout and hearing loss.

Clinical take-away

Early recognition of hearing loss associated with gout has a significant clinical implication. An increasing emphasis on hearing loss prevention and identification of novel risk factors such as gout paved the way for early diagnosis, prevention of severe hearing loss in ageing population and decreases the overall associated costs and disability.