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Abstract
Supplemental Digital Content is available in the text.
Objective:
To obtain updated robust data on a age-specific prevalence of hearing loss in Norway
and determine whether more recent birth cohorts have better hearing compared with
earlier birth cohorts.
Design:
Cross-sectional analyzes of Norwegian representative demographic and audiometric data
from the Nord-Trøndelag Health Study (HUNT)—HUNT2 Hearing (1996–1998) and HUNT4 Hearing
(2017–2019), with the following distribution: HUNT2 Hearing (N=50,277, 53% women,
aged 20 to 101 years, mean = 50.1, standard deviation = 16.9); HUNT4 Hearing (N=28,339,
56% women, aged 19 to 100 years, mean = 53.2, standard deviation = 16.9). Pure-tone
hearing thresholds were estimated using linear and quantile regressions with age and
cohort as explanatory variables. Prevalences were estimated using logistic regression
models for different severities of hearing loss averaged over 0.5, 1, 2, and 4 kHz
in the better ear (BE PTA4). We also estimated prevalences at the population-level
of Norway in 1997 and 2018.
Results:
Disabling hearing loss (BE PTA4 ≥ 35 dB) was less prevalent in the more recent born
cohort at all ages in both men and women (
p < 0.0001), with the largest absolute decrease at age 75 in men and at age 85 in women.
The age- and sex-adjusted prevalence of disabling hearing loss was 7.7% (95% confidence
interval [CI] 7.5 to 7.9) and 5.3% (95% CI 5.0 to 5.5) in HUNT2 and HUNT4, respectively.
Hearing thresholds were better in the more recent born cohorts at all frequencies
for both men and women (
p < 0.0001), with the largest improvement at high frequencies in more recent born 60-
to 70-year old men (10 to 11 dB at 3 to 4 kHz), and at low frequencies among the oldest.
Conclusions:
The age- and sex-specific prevalence of hearing impairment has decreased in Norway
from 1996–1998 to 2017–2019.
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation.
The HUNT Study includes large total population-based cohorts from the 1980ies, covering 125 000 Norwegian participants; HUNT1 (1984-86), HUNT2 (1995-97) and HUNT3 (2006-08). The study was primarily set up to address arterial hypertension, diabetes, screening of tuberculosis, and quality of life. However, the scope has expanded over time. In the latest survey a state of the art biobank was established, with availability of biomaterial for decades ahead. The three population based surveys now contribute to important knowledge regarding health related lifestyle, prevalence and incidence of somatic and mental illness and disease, health determinants, and associations between disease phenotypes and genotypes. Every citizen of Nord-Trøndelag County in Norway being 20 years or older, have been invited to all the surveys for adults. Participants may be linked in families and followed up longitudinally between the surveys and in several national health- and other registers covering the total population. The HUNT Study includes data from questionnaires, interviews, clinical measurements and biological samples (blood and urine). The questionnaires included questions on socioeconomic conditions, health related behaviours, symptoms, illnesses and diseases. Data from the HUNT Study are available for researchers who satisfy some basic requirements (www.ntnu.edu/hunt), whether affiliated in Norway or abroad.
Background Population based studies are important for prevalence, incidence and association studies, but their external validity might be threatened by decreasing participation rates. The 50 807 participants in the third survey of the HUNT Study (HUNT3, 2006-08), represented 54% of the invited, necessitating a nonparticipation study. Methods Questionnaire data from HUNT3 were compared with data collected from several sources: a short questionnaire to nonparticipants, anonymous data on specific diagnoses and prescribed medication extracted from randomly selected general practices, registry data from Statistics Norway on socioeconomic factors and mortality, and from the Norwegian Prescription Database on drug consumption. Results Participation rates for HUNT3 depended on age, sex and type of symptoms and diseases, but only small changes were found in the overall prevalence estimates when including data from 6922 nonparticipants. Among nonparticipants, the prevalences of cardiovascular diseases, diabetes mellitus and psychiatric disorders were higher both in nonparticipant data and data extracted from general practice, compared to that reported by participants, whilst the opposite pattern was found, at least among persons younger than 80 years, for urine incontinence, musculoskeletal pain and headache. Registry data showed that the nonparticipants had lower socioeconomic status and a higher mortality than participants. Conclusion Nonparticipants had lower socioeconomic status, higher mortality and showed higher prevalences of several chronic diseases, whilst opposite patterns were found for common problems like musculoskeletal pain, urine incontinence and headache. The impact on associations should be analyzed for each diagnosis, and data making such analyses possible are provided in the present paper.
Publisher:
Lippincott Williams & Wilkins
(Hagerstown, MD
)
ISSN
(Print):
0196-0202
ISSN
(Electronic):
1538-4667
Publication date Collection: Jan-Feb 2021
Publication date
(Electronic):
12
June
2020
Volume: 42
Issue: 1
Pages: 42-52
Affiliations
[1
]Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo,
Norwayl
[2
]Department of Occupational Medicine and Epidemiology, National Institute of Occupational
Health, Oslo, Norway.
Author notes
Address for correspondence: Bo Engdahl, Department of Chronic Diseases and Ageing,
Norwegian Institute of Public Health, Postboks 222 Skøyen, Norway. E-mail:
bolars.engdahl@
123456fhi.no
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