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Hearing loss is greater among people living in rural areas, study finds


How's your hearing? New research estimates that nearly 40 million Americans have hearing loss. That's about 11% of the population. It also finds something that may surprise you. Hearing loss is more common in rural areas than urban ones. The study was led by the social research organization NORC at the University of Chicago and is the first to estimate hearing loss rates at the state and county level. Audiologist Nicholas Reed of Johns Hopkins University co-authored the study and joins us now. Welcome to the program.

NICHOLAS REED: Yeah, thanks for having me.

RASCOE: So people would tend to think of cities as being far noisier than the country, so what might account for hearing loss being more prevalent in rural areas?

REED: Yeah. So on average, you're absolutely correct. Cities are what we consider noisy, right? You ride the Metro in D.C. You ride the subway in New York City. It's loud. But if you think about the occupations in rural areas - logging industry, mining industry, even recreational things like quite literally snowmobiling and dirt biking and recreational firearm use - these are really loud. And you combine that on top of sort of lower health resource access, plus overall, you know, poorer health behaviors - smoking is more common in rural areas. More likely to have a stroke in rural areas, cardiovascular risk factors - likely due to that poor health care access, then it's sort of a recipe for poor hearing, even when you adjust for age or race or sex. So that's a big finding on our part.

RASCOE: Yeah, and so what you're saying is this is not something that you expected. This was surprising to you guys?

REED: We might have expected in the beginning that rural areas tend to be older, and hearing loss is so closely associated with age that we thought, oh, yeah, well, that makes sense. But then when you adjust for age and it's still there - and, you know, we created this nice interactive map. And you look at things like Florida which have, you know, some much older counties, and they're still not as high on the percentage of hearing loss as some of these counties in especially Appalachia - you know, West Virginia, getting into Virginia state and then Tennessee - we knew something was going on, and it led us to sort of look a little bit deeper.

RASCOE: But you're saying that the incidents that can damage hearing are more prevalent in rural places, meaning, like, having these jobs like logging or doing a lot of, like, shooting guns or anything like that - I mean, they're very loud.

REED: You know, noise - we measure noise on what's called a logarithmic scale. Eighty decibels to 90 decibels is not the same as 110 to 120, right? So you can sit in 80 decibels on average for, you know, according to OSHA, eight hours. When you get to 120 decibels, 130 decibels, you have minutes to seconds before it potentially causes damage. And the activities like gunfire - you know, upwards of 120, 140. The equipment used in logging and mining is incredibly loud. And so we really are entering into sort of dangerous territories where it doesn't take long, whereas if you ride all the way across the Metro in D.C., it's not the same as literally just a second of gunfire.

RASCOE: Looking at hearing loss at the state and county level, how do you hope this data will be used?

REED: The most interesting thing about this isn't even just the story of the paper. It's going deeper that we created this interactive map that also lays on top of where hearing loss is more prevalent and the number of audiologists and hearing care professionals in a region. And what you see is that where hearing loss is the most prevalent - the highest-risk areas in the United States have the lowest concordance of actual hearing care. And so from a policy perspective, you know, this opens up - we need to be thinking about telehealth models, mobile health models. We need to be getting the care to where this group is and building awareness for prevention and protection.

RASCOE: As an audiologist, do you think that where there is access - that they should be talking more with their patients about getting tested or taking precautions to protect their hearing? Or even that physicians who probably will see their patients more often - that they should be telling their patients to go see an audiologist?

REED: We need to start thinking more about hearing across the lifespan and, you know, getting people to screen and, you know, universal screening programs and even just reframing the concept of hearing loss as a binary thing that, one day, it's this life event that you just have hearing loss - to your hearing changes across your lifespan. I think the other part of this is really the proper education on prevention. Because we sort of stop prevention and testing in elementary ages, we have older adults that we sort of say, OK, well, you know, damage is done. You need hearing aids. And we only focus on treatment. But prevention makes a huge difference, and so I really think this is one of those moments for audiologists that - it's not just about what we do in our clinics. It's about building sort of this community-based hearing care ecosystem that builds awareness and prevention and not just treatment.

RASCOE: That's Nicholas Reed, an audiologist and assistant professor at Johns Hopkins University Bloomberg School of Public Health. Thank you so much for talking with us.

REED: Thank you for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.