Investigating ethnic inequalities in hearing aid use in England and Wales: a cross-sectional study

Abstract

Objective

To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults.

Design

Cross-sectional data from the UK Biobank resource.

Study sample

164,460 participants aged 40–69 who answered hearing questions at an assessment centre in England or Wales.

Results

After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, there were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17–0.77), Black Caribbean (OR 0.38, 95% CI 0.22–0.65) and Indian (OR 0.60, 95% CI 0.41–0.86) ethnic groups, compared to the White British or Irish group. Men from most ethnic minority groups and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts.

Conclusions

For equivalent levels of hearing loss, the use of hearing aids is lower among ethnic minority groups. Inequalities are partly due to lower levels of self-reported hearing difficulty among minority groups. However, even when self-reported hearing difficulty is considered, hearing aid use remains lower among many ethnic minority groups.

Keywords:

• Hearing aids
• hearing aid
• ethnicity
• inequalities
• hearing health

Acknowledgements

We would like to thank Professor James Nazroo for his very helpful comments which contributed to an early draft of the manuscript. We would also like to thank the three anonymous reviewers whose thoughtful and helpful comments and suggestions greatly improved our manuscript.

Supplied by author

This is the first research to produce an unbiased view of ethnic inequalities in hearing aid use in England and Wales. By correcting for bias in the hearing test used in the UK Biobank data (Digit Triplet Test), as well as self-reported hearing difficulty, we can conclude that for Indian, Black African and Black Caribbean groups, there are additional barriers to being fitted with a hearing aid that are not faced by those of White British and Irish ethnicity.

Ethnic inequalities in hearing aid use, especially in the UK, are a seldom-researched topic. The present research has the potential to raise awareness among the audiology community of an avoidable health inequality, the nature of which may be surprising to many. Even though hearing aids are freely available on the NHS, the present research shows that they are not accessed equally. The present research is intended to provoke a discussion on why these inequalities may exist, and what can be done to tackle them.

Ethical approval

The UK Biobank received ethical approval from the National Health Service Research Ethics Service North West (11/NW/0382).

Informed consent from participants

Explicit consent for secondary analyses such as the one reported here was obtained from participants in the UK Biobank.

Data availability statement

Data are available in a public, open access repository. The UK Biobank data are held in an open-access resource available to researchers via the procedure described at https://ukbiobank.ac.uk/enable-your-research.

Author contributions

All authors made substantial contributions to the conception and design of the study, and interpretation of results. HT also analysed the data and drafted the manuscript. PD, DK, NS and PN also critically revised the manuscript. All authors approved the final version and agree to be accountable for all aspects of the work.

Additional information

Funding

This work was supported by the Economic and Social Research Council [grant numbers ES/P000665/1 and ES/V013475/1] and the NIHR Manchester Biomedical Research Centre.