Priorities for hearing loss prevention based on population attributable fraction estimates: a cross-sectional analysis within the China national health survey 2023

Hearing loss (HL) is a preventable common disease with over 1.5 billion patients globally, but the contribution of its risk factors has been incompletely studied. We aimed to estimate the attributions of certain preventable socioeconomic and cardiometabolic causes and identify the leading attributable risk factors. We did a cross-sectional survey using data from the China National Health Survey, including 6291 aged 20–88 years participants. The hearing was measured using air-conduction pure-tone audiometry. Low/mid-frequency (pure-tone average [PTA] threshold at 0.5, 1, and 2 kHz), speech-frequency (PTA threshold at 0.5, 1, 2, and 4 kHz), and high-frequency (PTA threshold at 4, 6, and 8 kHz) HL were defined as PTA > 20 dB hearing loss in the better ear. We estimated the population attributable fractions (PAF) and 95% confidence interval (CI) based on multivariable logistic models and further stratifying by age, sex, and menopausal status. About 10%-19% of HL were attributed to socioeconomic and cardiometabolic risk factors. The PAFs and their rank of risk factors were generally consistent for all frequency-specific HL. Abnormal BMI (about 3.0%-6.5% of the PAF) and low education (about 2.7%-5.5% of the PAF) were the leading attributable risk factors. Hypertension in older adults and males also have high PAF. The PAFs of selected risk factors for HL were higher in younger than older adults, in males than females, and in premenopausal than postmenopausal females. The disparities in the contributions of specific populations suggested priorities for HL prevention. Weight and blood pressure management could be initial targets for HL prevention strategies.