Association between social determinants of health and hearing loss in South African children: A secondary data analysis

Globally, 34 million children below 15 years have hearing loss (HL) and while research shows associations between social determinants of health and disability in general, research on the associations between these determinants and HL in children is limited. Therefore, this study sought to examine the association between social determinants of health and HL in children using the parental socioeconomic status, such as educational attainment level, employment status and income level, non-medical determinants of health (rurality, housing, type of toilet, availability of piped drinking water, and exposure to cigarette smoke) as proxy factors for social determinants of health in children. This was a secondary data analysis of a cross-sectional survey conducted with 517 children in South Africa. We conducted multivariable logistic regression to test for the association between HL and exposure variables such as non-medical determinants of health and parental socioeconomic status using Stata v18 for Macintosh. Odds ratios (OR) with 95% confidence intervals (CIs) were used to ascertain the odds of HL with exposure variables. One hundred and two participants (n = 102, 19.7%) had HL, including 57 (55.9%) females. Crude analysis showed increased odds of HL in females (OR:1.6; 95%CI: 1.0 - 2.5, P = 0.03) and children younger than9 years (OR: 2.0; 95%CI: 1.3 - 3.1, P = 0.003). After adjusting for age and sex, exposure to cigarette smoke (aOR: 4.0; 95%CI:2.4 - 6.4, P < 0.001), living in a mud house (aOR: 1.6; 95%CI:1.2 - 2.7, P = 0.04), lack of piped drinking water (aOR: 1.9; 95%CI:1.1 - 3.1, P < 0.02), using pit latrines (aOR: 4.1; 95%CI:1.3 - 13.0, P = 0.01), having parents who (i) did not complete high school (aOR: 2.8; 95%CI:1.4 - 2.4, P = 0.01), or those earning a combined annual household income (iii) less than $2,882 (aOR: 6.2; 95%CI:2.1 - 51.1, P = 0.03) or (iv) between $2,883 and $8,006 (aOR:5.0; 95%CI:2.5 - 43.5, P = 0.05) increased the odds of HL. Based on these findings, we recommend public health interventions targeting these social determinants to reduce the global burden of HL, and further research to understand the pathophysiology of HL in those exposed to smoking or using pit latrines.