Advocacy & Research | May 2019 Hearing Review

A new EU study points to the extraordinary economic impact of hearing loss

A new study compiled for the non-profit organization Hear-It estimates that disabling hearing loss (?35 dB HL) costs €216 billion per year in Europe. Applying the report methodology to the United States, the conclusions are that approximately 14.6 million people in the USA live with an untreated, disabling hearing loss, with a cost of $133 billion each year. This amounts to $9,100 per person with an untreated disabling hearing loss.

Using hearing aids contributes to better health, higher income, and better family and social life—and has a huge positive effect on Gross National Product. These are the overall conclusions of a new and large scientific study, titled “Hearing Loss–Numbers and Costs1 about the consequences of hearing loss. The study, conducted for the non-profit organization Hear-it, documents that 7% of all adults live with a disabling hearing loss, and more than 2 out of 3 of these people are not treated for their disabling hearing loss. In the United States alone, we estimate the costs of disabling hearing loss equals $133 billion a year.

Bridget Shield, PhD

Bridget Shield, PhD

“Hearing Loss–Numbers and Costs” is a meta study that has analyzed and compared hundreds of scientific studies and papers in the last two decades about the prevalence and the consequences of hearing loss and the use and benefits of hearing aids. The report clearly documents that untreated hearing loss is a major health issue having a huge negative economic and social impact on our society. It also documents that checking your hearing and treating hearing loss pays off—both for the individual and for society. The report has been compiled for hear-it AISBL by Bridget Shield, PhD, with the assistance of professor Mark Atherton at Brunel University, London. Dr Shield is a professor emerita and a retired professor of Acoustics at the School of The Built Environment and Architecture at London South Bank University, and in 2006 she compiled the first report for hear-it AISBL, “Evaluation of the Social and Economic Costs of hearing Impairment.”2

European Hearing Loss Statistics

Figure 1. Quality of Life (in red) and Productivity (in red) losses in Europe due to untreated disabling hearing loss for the EU28 and other European countries in billions of Euros.

[Click on images to enlarge.] Figure 1. Quality of Life (in red) and Productivity (in red) losses in Europe due to untreated disabling hearing loss for the EU28 and other European countries in billions of Euros.

The new report finds that disabling hearing loss (defined as a hearing loss of 35 dB or greater) costs €185 billion (US$210 billion) in the 28 countries that currently make up the European Union (EU28) each year because of lower quality of life and less productivity (Figure 1). This equates to €8,200 each year per person in Europe with an untreated disabling hearing loss (Figure 2).

Lower quality of life due to disabling hearing loss costs €130 billion (US$148 billion) each year in the EU28. Lost productivity in society due to a higher unemployment among people with a disabling hearing loss costs another €55 billion (US$62 billion) each year—totaling €185 billion in the EU28. The costs calculated in the report do not cover additional increased healthcare costs due to untreated hearing loss. In Europe as a whole, including countries outside the EU, disabling hearing loss costs €216 billion (US$244 billion) in quality of life and lost productivity.

Extrapolating the Statistics to the US

Figure 2. Total annual cost per person (in Euros and US dollars) in Europe and the United States of people with untreated disabling hearing loss. The US figure is based on an estimated 14.6 million people with a 35 dB or greater hearing loss and a total cost of $133 billion.

Figure 2. Total annual cost per person (in Euros and US dollars) in Europe and the United States of people with untreated disabling hearing loss. The US figure is based on an estimated 14.6 million people with a 35 dB or greater hearing loss and a total cost of $133 billion.

Even given the differences in various countries’ healthcare systems, the United States and Europe are quite comparable in terms of demographics and economics. Applying the report methodology and findings to the United States, the conclusions suggest that around 14.6 million people in the USA live with an untreated, disabling hearing loss, and untreated disabling hearing loss in the USA costs $133 billion each year. This amounts to $9,100 per person with an untreated disabling hearing loss (Figure 2).

Importantly, the costs calculated in the report do not cover additional increased healthcare costs because of untreated hearing loss. A recent study led by researchers at the Johns Hopkins Bloomberg School of Public Health, showed that for people with an untreated hearing loss, healthcare costs increase by 46%—or by $22,434 per person over a period of 10 years—compared to people without a hearing loss.3

Methodology

In the report, the number of adults and number of people of working age are extrapolated from 2017 Global Burden of Disease (GBD) data. The GBD website4 shows the numbers in different categories of HL (mild to complete) for various age ranges: <5, 5-14, 15-49, 50-69, 70+ years, as well as all ages.

The Global Burden of Disease (GBD) estimates contribute to the World Health Organization’s (WHO) global health estimates. The GBD study is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk  factors. GBD is a collaboration of over 1,800 researchers from 127 countries and based at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. A “disabling hearing loss” is defined by the GBD research group as a hearing loss greater than 35 dB on the better ear.

GDP per capita for each country in the report are taken from the IMF website5 using July 2018 data. The health utility indices for hearing loss in the different brackets of hearing loss are estimated by Dr Shield, based on previous studies of health utility indices for hearing loss. The economic output per person is calculated from the IMF website using July 2018 data, and number of employed people is taken from Trading Economics website.6 Employment rates for the 15-64 age group are also taken from the Trading Economics website.

In the report, the prevalence of hearing aid use is a European average and is estimated on the basis of a series of surveys (EuroTrak)7-9 about hearing aid use in different European countries. The numbers and figures given overall and for individual countries are estimates and hence not exact figures.

By the Numbers: The Cost of Untreated Hearing Loss

Figure 3. Number of people (in millions) in Germany, Italy, the UK, France, Spain, and Poland with a disabling hearing loss of 35 dB or greater (left column) and those with an untreated disabling hearing loss (right column).

Figure 3. Number of people (in millions) in Germany, Italy, the UK, France, Spain, and Poland with a disabling hearing loss of 35 dB or greater (left column) and those with an untreated disabling hearing loss (right column).

Number of people with hearing loss. There are 34.4 million people with a disabling hearing loss (35 dB or greater) in the EU. In Europe as a whole, there are 47.9 million people who are living with a disabling hearing loss. Figure 3 shows the statistics for six select countries as an example. About 2 out of 3 are not treated for their disabling hearing loss. The EuroTrak surveys7-9 made in several European countries show that, on average, 12.5% of European adults say that they have a hearing loss. This represents a larger figure than the estimated 47.9 million with a disabling hearing loss, as it includes all those who report a hearing loss less severe than 35 dB.

Ownership of hearing aids. The EuroTrak surveys7-9 show that, on average, 35% of Europeans with a hearing loss use hearing aids. The use of hearing aids increases with age and the severity of the hearing loss.

The MarkeTrak studies that have been carried out in the United States for several years show that the percentage of people with hearing loss who use hearing aids is slightly lower compared to Europe. About 65% of Europeans with a hearing loss do not use hearing aids compared to about 70% of people in the United States. This is despite the fact that the report (along with others) documents that both the individual hearing-impaired person and society as a whole will benefit from the use of hearing aids in many ways.

Earnings and income. The report provides considerable evidence that people with hearing loss, on average, earn significantly  less than people with normal hearing. People with an untreated hearing loss experience higher unemployment rates than people without hearing loss. The employment rate among people of working age with hearing loss is 83% of the employment rate among the population in general. Early retirement and less demanding jobs also contribute to why the average income of people with hearing loss is below that of people with normal hearing.

Hearing aid users earn significantly more than hearing impaired non-users. The difference between the two groups increases with the severity of the hearing loss and unemployment rates for non-users are approximately twice those of hearing aid users.

The 2010 MarkeTrak VIII survey10,11 in the United States found that people with untreated hearing loss lose as much as $30,000 annually, depending on their degree of hearing loss. Like our study, MT8 also showed a strong relationship between degree of hearing loss and unemployment for unaided subjects.

Quality of life. People with an untreated hearing loss experience lower quality of life.12-14 On average, the more severe the hearing loss, the greater the loss in quality of life, as demonstrated by Table 1. In fact, the report suggests that hearing loss has more of an impact on quality of life than many other chronic conditions.

Table 1. Health Utilities Index (HUI) values assigned to grades of hearing loss. The HUI provides a single-summary score of health-related quality of life (HRQL) for each health state. The loss in HUI due to hearing loss again assumes an HUI of 0.85 for the general, unimpaired population.

Table 1. Health Utilities Index (HUI) values assigned to grades of hearing loss. The HUI provides a single-summary score of health-related quality of life (HRQL) for each health state. The loss in HUI due to hearing loss again assumes an HUI of 0.85 for the general, unimpaired population.

Consequences of an untreated hearing loss. We have documented that untreated hearing loss has a series of negative physical, mental, and social consequences. Untreated hearing loss can lead to depression, loneliness, and social isolation.15 Untreated hearing loss also has multiple effects on personal and family relationships.12-14

Figure 4. Infographic available from Hear-It on the results of the new study.

Figure 4. Infographic available from Hear-It on the results of the new study.

When looking at the general population, untreated hearing loss influences general physical health and wellbeing, and reduces physical activity. People with untreated hearing loss are also more likely to have other chronic diseases than people with normal hearing.13,16 There is also a documented relationship between untreated hearing loss and cognitive decline and dementia.17,18 Fatigue, both during and after work, is a major problem affecting many people with an untreated hearing loss.

It is interesting to note that when considering the IHME’s Global Burden of Disease, hearing loss affects people’s lives more negatively than both blindness and vision impairments, as well as more than Alzheimer’s and other forms of dementia.

Acknowledgements

This study was funded by Hear-it AISBL, an international non-commercial organization, based in Brussels, Belgium. The objective of Hear-it AISBL is to collect, process, and circulate up-to-date scientific information and other relevant information about hearing loss and its human and socio-economic consequences, as well as the possibilities and benefits of treating hearing loss.

The members of Hear-it AISBL include The International Federation of the Hard of Hearing (IFHOH), the European Federation of Hard of Hearing People (EFHOH), the European Association of Hearing Aid Professionals (AEA), and individual members from the hearing aid industry. Hear-it AISBL maintains one of the world’s largest and leading websites featuring hearing-related information at www.hear-it.org

References

  1. Shield B. Hearing loss–Numbers and costs. Evaluation of the social and economic costs of hearing impairment. Brussels, Belgium: Hear-It. February 2019. Available at: https://www.hear-it.org/sites/default/files/BS%20-%20report%20filesHearitReportHearingLossNumbersandCosts.pdf

  2. Shield B. Evaluation of the social and economic costs of hearing impairment. A report for Hear-It. October 2006. Available at: https://www.hear-it.org/sites/default/files/multimedia/documents/Hear_It_Report_October_2006.pdf

  3. Reed NS, Altan A, Deal JA, Yeh C, Kravetz AD, Wallhagen M, Lin FR. Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngol Head Neck Surg. 2018: Nov 8. doi: 10.1001/jamaoto.2018.2875

  4. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease (GBD). 2017. Available at: http://vizhub.healthdata.org/gbd-compare

  5. International Monetary Fund (IMF). IMF website. Available at: https://www.imf.org/external/index.htm

  6. Trading Economics website. Available at: https://tradingeconomics.com

  7. European Hearing Instrument Manufacturers Assn (EHIMA). EuroTrak surveys (2009-2018). Available at: https://www.ehima.com/eurotrak

  8. Hougaard S, Ruf S, Egger C. EuroTrak + JapanTrak 2012: Societal and personal benefits of hearing rehabilitation with hearing aids. Hearing Review. 2013;20(3)[Mar]:16-26. Available at: http://www.hearingreview.com/2013/03/eurotrak-japantrak-2012-societal-and-personal-benefits-of-hearing-rehabilitation-with-hearing-aids/

  9. Hougaard S, Ruf S. EuroTrak I: A consumer survey about hearing aids in Germany, France, and the UK. Hearing Review. 2011;18(2)[Feb]:12-28. Available at: http://www.hearingreview.com/2011/02/eurotrak-i-a-consumer-survey-about-hearing-aids-in-germany-france-and-the-uk

  10. Kochkin S: The impact of untreated hearing loss on household income. Alexandria, VA: Better Hearing Institute, May 2010.

  11. Kochkin S. MarkeTrak VIII: The efficacy of hearing aids in achieving compensation equity in the workplace. Hear Jour. 2010;63(10):19-28.

  12. Hougaard S, Ruf S, Egger C, Abrams H. Hearing aids improve hearing–and A LOT more. Hearing Review. 2016;23(6):14.

  13. Abrams H. Hearing loss and associated comorbidities: What do we know? Hearing Review. 2017;24(12):32-35. Available at: http://www.hearingreview.com/2017/11/hearing-loss-associated-comorbidities-know/

  14. Kochkin S, Rogin C. Quantifying the obvious: The impact of hearing instruments on quality of life. Hearing Review. 2000; 7(1):6-34. Available at: http://a360-wp-uploads.s3.amazonaws.com/wp-content/uploads/hearingr/2019/01/KochkinRogin_QuantifyingObvious_0100HR.pdf

  15. Bray VH. Depression, Hearing Loss, and Treatment with Hearing Aids [webinar]. July 13, 2018. Available at: http://www.hearingreview.com/2018/07/new-webinar-depression-hearing-loss-treatment-hearing-aids

  16. Deal JA, Reed NS, Kravetz AD, et al. Incident hearing loss and comorbidity. JAMA Otolaryngol Head Neck Surg. 2019;145(1):36-43. doi:10.1001/jamaoto.2018.2876

  17. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734.

  18. Amieva H, Ouvrard C, Giulioli C, Meillon C, Rullier L, Dartigues J-F. Self-reported hearing loss, hearing aids, and cognitive decline in elderly adults: A 25-year study. J Am Geriatr Soc. 2015;63(10):2099-2104.

 


CORRESPONDENCE
can be addressed to Kim Ruberg at: editor@hear-it.org

Kim Ruberg, Hear-it

Kim Ruberg, Hear-it

About the author: Kim Ruberg is Secretary General of Hear-it AISBL, headquartered in Brussels, Belgium.