Fall-related Injuries Mediate the Relationship between Self-Reported Hearing Loss and Mortality in Middle-Aged and Older Adults.

BACKGROUND Hearing loss is associated with a greater risk of death in older adults. This relationship has been attributed to an increased risk of injury, particularly due to falling, in individuals with hearing loss. However, the link between hearing loss and mortality across the lifespan is less clear. METHODS We used structural equation modeling and mediation analysis to investigate the relationship between hearing loss, falling, injury, and mortality across the adult lifespan in public-use data from the National Health Interview Survey and the National Death Index. We examined 1) the association between self-reported hearing problems and later mortality, 2) the associations between self-reported hearing problems and the risk of injury and degree and type of injury, 3) the mediating role of falling and injury in the association between self-reported hearing problems and mortality, and 4) whether these relationships differ in young (18-39), middle-aged (40-59) and older (60+) age groups. RESULTS In all three age ranges, those reporting hearing problems were more likely to fall, were more likely to sustain an injury, and were more likely to sustain a serious injury, than those not reporting hearing problems. While there was no significant association between hearing loss and mortality in the youngest category, there was for middle-aged and older participants and for both fall-related injury was a significant mediator in this relationship. CONCLUSIONS Fall-related injury mediates the relationship between hearing loss and mortality for middle-aged as well as older adults, suggesting a need for further research into mechanisms and remediation.