Differential Associations Between Social Connection and Quality of Life by Hearing Loss Status Among Older Adults: An Urban-Rural Comparison

Purpose: This study examined whether hearing loss moderates the association between social connection and quality of life (QoL) among older Korean adults and whether this pattern differs by urban-rural residence.Methods: Using the 2023 Korean national survey of older persons (n = 9,951), multivariable linear regression models were estimated for the full sample and for hearing-loss, non-hearing-loss, urban, and rural subgroups. Models controlled for sociodemographic characteristics, hearing aid use, cognitive function, and depressive symptoms. Interaction terms between hearing loss and social connection were added to the urban and rural models to assess moderation.Results: In the full sample, social connection was positively associated with QoL, most strongly for frequent contact with friends/neighbors, fellowship-group participation, and contact with children. Hearing loss was negatively associated with QoL in both rural and urban areas, even after full adjustment. Fewer social connection variables were significantly associated with QoL in the hearing-loss group; less frequent contact with friends/neighbors, volunteering, and educational activities mattered only among those without hearing loss. Negative interactions emerged for frequent contact with friends/neighbors and fellowship-group participation in rural areas and for contact with friends/neighbors in urban areas, whereas a positive interaction with frequent contact with children appeared only in urban areas.Conclusion: Hearing loss was associated with lower QoL, and moderating patterns emerged selectively, involving different relationship types in urban and rural areas. Interventions may need to address not only audiological impairment but also the communicative demands of older adults’ social environments.