The leaky pipeline of hearing care: primary to secondary care evidence from the English Longitudinal Study of Ageing (ELSA)

Figures & data

Table 1. Summary of multiple logistic regression for variables predicting the non-report of an acknowledged hearing difficulty to a doctor or nurse in primary care in the English Longitudinal Study of Ageing (ELSA) Wave 7.

	Model I^a		Model II^b		Model III^c
Predictor	Did not report hearing loss to a doctor or a nurse in primary care while they had moderate or worse hearing loss	Corrected odds ratio^d	Did not report hearing loss to a doctor or a nurse in primary care while they had moderate hearing loss	Corrected odds ratio	Did not report hearing loss to a doctor or a nurse in primary care while they had moderately severe or severe hearing loss	Corrected odds ratio
Gender (female)	1.45 (1.14–1.86)*	2.68 (2.14–2.98)	1.39 (1.04–1.86)	2.36 (2.13–2.62)	1.05 (0.58–1.90)	1.10 (0.99–1.22)
Age (65–74)	0.78 (0.57–1.07)	0.51 (0.46–0.57)	0.74 (0.51–1.06)	0.43 (0.39–0.48)	0.97 (0.42–2.21)	0.90 (0.81–1.0)
Age (75–89)	0.56 (0.40–0.79)	0.15 (0.14–0.17)	0.58 (0.39–0.86)	0.18 (0.16–0.20)	0.72 (0.31–1.70)	0.40 (0.36–0.44)
Retirement status (not retired)	1.12 (0.87–1.56)	1.30 (1.17–1.44)	1.13 (0.81–1.59)	1.33 (1.20–1.48)	1.32 (0.66–2.63)	2.03 (1.83–2.25)
Education (Foreign/Other)	1.46 (1.01–2.10)	2.74 (2.47–3.04)	1.53 (0.99–2.38)	3.19 (2.87–3.54)	1.27 (0.57–2.83)	1.82 (1.64–2.02)
Education (O level/ CSE grade)	1.48 (1.08–2.02)	2.86 (2.58–3.18)	1.52 (1.06–2.21)	3.12 (2.81–3.46)	0.76 (0.35–1.67)	0.47 (0.42–0.52)
Occupation (routine/manual)	1.05 (0.78–1.40)	1.10 (0.99–1.22)	1.21 (0.87–1.70)	1.60 (1.44–1.78)	0.83 (0.41–1.66)	0.60 (0.54–0.67)
Income (lowest)	1.00 (0.91–1.10)	0.97 (0.87–1.08)	0.96 (0.86–1.07)	0.88 (0.79–0.98)	1.13 (0.89–1.44)	1.33 (1.20–1.48)
Smoking habit (current)	1.67 (1.11–2.53)	4.39 (3.95–4.87)	1.28 (0.79–2.01)	1.86 (1.68–2.06)	3.34 (1.42–7.89)	6.46 (5.82–7.17)
Excessive alcohol consumption (>14 units/week)	1.23 (0.99–1.54)	1.67 (1.50–1.85)	1.16 (0.90–1.49)	1.43 (1.29–1.59)	1.34 (0.78–2.31)	2.12 (1.91–2.35)
Physical Activity (moderate sports or activities hardly ever, or never)	0.96 (0.86–1.06)	0.88 (0.79–0.98)	1.00 (0.88–1.13)	0.97 (0.87–1.08)	0.87 (0.69–1.10)	0.68 (0.61–0.75)

^a MODEL I: The sum of those who rated their hearing as fair or poor on a 5-point Likert scale (with 1 indicating excellent; 2, very good; 3, good; 4, fair; and 5, poor) or responded that they have moderate or great difficulty in following a conversation if there is background noise (such as television, radio, or children playing).

^b MODEL II: Moderate self-reported hearing difficulty: if their hearing was fair OR had moderate difficulty following a conversation in background noise.

^c MODEL III: Moderately severe or severe self-reported hearing difficulty: if their hearing was poor OR had great difficulty following a conversation in background noise.

^d Odds ratio corrected based on sensitivity 69.8% (95% CI 67.9–71.7), and specificity 69.3% (95% CI 68.1–70.4) after comparison with data from HearCheck Screener.

* Data in brackets refer to 95% CI, and statistically significant results are presented in bold.

Figure 1. The questions on hearing loss, hearing in noise, and hearing aid recommendation in the English Longitudinal Study of Ageing (ELSA) Wave 7 (n = 8529). ^aThe sum of those who rated their hearing as fair or poor on a 5-point Likert scale (with 1 indicating excellent; 2, very good; 3, good; 4, fair; and 5, poor) or responded that they have moderate or great difficulty in following a conversation if there is background noise (such as television, radio, or children playing). ^bTwo participants responded “I do not know” and were excluded from the analysis.

Figure 2. The questions on hearing aid uptake and use in the English Longitudinal Study of Ageing (ELSA) Wave 7 among those with self-reported hearing loss^a (n = 2249). ^aThe sum of those who rated their hearing as fair or poor on a 5-point Likert scale (with 1 indicating excellent; 2, very good; 3, good; 4, fair; and 5, poor) or responded that they have moderate or great difficulty in following a conversation if there is background noise (such as television, radio, or children playing). ^bOne participant responded “I do not know” and was excluded from the analysis.

Figure 3. Behaviour on hearing aids use among 1145 participants who acknowledged hearing loss, disclosed it to a doctor or nurse in primary care, and were referred to an ear specialist to check their hearing (data from the English Longitudinal Study of Ageing (ELSA) Wave 7, a nationally representative cohort of 8529 older adults aged 50 years old and above in England).

Figure 4. Proportions of participants in the English Longitudinal Study of Ageing (ELSA) Wave 7 with self-reported hearing loss^a who leave the hearing pathway before the successful completion of the corresponding stage. ^aThe sum of those who rated their hearing as fair or poor on a 5-point Likert scale (with 1 indicating excellent; 2, very good; 3, good; 4, fair; and 5, poor) or responded that they have moderate or great difficulty in following a conversation if there is background noise (such as television, radio, or children playing).

Data availability statement

The English Longitudinal Study of Ageing dataset is publicly available via the UK Data Service (http://www.ukdataservice.ac.uk). Statistical code is available from the corresponding author upon request at [email protected].