Hearing impairment and depression in middle-aged and older Chinese adults: the potential intermediary role of sleep duration in the CHARLS cohort

Hearing impairment has been associated with depressive symptoms in older adults. Sleep duration may represent a potential contributing factor linking these conditions. We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2015), including 12,934 participants aged ≥ 45 years. Hearing impairment was defined by self-report, depressive symptoms by CES-D10 ≥ 10, and sleep duration as average nightly sleep hours. Logistic regression models were used to estimate associations, adjusting for sociodemographic and health-related covariates. To explore whether sleep duration contributed to the observed association, we compared effect estimates before and after adjustment for sleep duration. Hearing impairment was associated with higher odds of depressive symptoms (OR = 1.83, 95% CI: 1.69–1.97). After further adjustment for sleep duration, the association was slightly attenuated (OR = 1.77, 95% CI: 1.63–1.91), suggesting that sleep duration may contribute modestly to the observed relationship. Stratified analyses showed similar patterns across subgroups. Self-reported hearing impairment is associated with depressive symptoms among middle-aged and older Chinese adults. Sleep duration may partially contribute to this association, although causal inference cannot be established.