Nonlinear Association Between Alcohol Intake and Hearing Among Older Adults: Evidence From NHANES 2015 to 2023

OBJECTIVE: This study aimed to investigate the potential nonlinear association between alcohol intake and hearing loss among older adults. STUDY DESIGN: A cross-sectional analysis based on nationally representative survey data. SETTING: Data were drawn from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2023. METHODS: A total of 2169 US adults aged 60 years and older were included. We used weighted multi-variable regression to examine the relationship of daily alcohol consumption (g/day) and hearing loss scores. We examined nonlinear associations using smoothing curves, and then threshold effects using 2 piecewise-linear regression equations. We also performed separate analyses stratified by sex to check robustness of associations. RESULTS: A non-linear, inverted U-shaped association was observed between alcohol intake and hearing loss scores, with an inflection point at approximately 23 g/day. Alcohol intake below this level was associated with lower hearing loss scores (β = -1.16, 95% CI: -1.83 to -0.49), whereas intake above the threshold was associated with higher scores (β = 1.01, 95% CI: 0.51 to 1.51). Sex-stratified analyses showed a similar nonlinear pattern among men (inflection point ≈ 14 g/day) but not among women. CONCLUSION: These findings indicate a sex- and age-specific, nonlinear association between alcohol intake and auditory function among older adults within the observed range of alcohol consumption. Moderate levels of alcohol intake were associated with lower hearing loss scores, whereas higher levels of intake were associated with higher hearing loss scores.