Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study
Objectives: This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids. Design: We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity. Results: An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs. Conclusions: Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.
Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019
Abstract Introduction: Prognosis in CLL is heterogeneous with the elderly, males and those with multiple co-morbidities having the highest risk of poorer outcomes. Whether this reflects differences in the biology of CLL or the result of altered immunosuppression is unknown. In normal individuals, the telomeres in somatic cells shorten with age, predisposing those with shorter telomeres to death from infections, cancer and cardiovascular disease. In chronic lymphocytic leukemia (CLL), short telomere length in the leukemia cells predicts poor prognosis. The contribution of un-modifiable factors of age, sex or comorbidities to telomere shortening in CLL has not been elucidated. In the present study, we evaluated buccal cell (BC) telomere length in patients with CLL, to determine if this is predictive of survival, and can enhance the predictive value of leukemia cell telomere length. Methods: The Manitoba CLL tumor bank contains 168 samples from newly diagnosed CLL patients between 2007-2011; with a median follow-up of 4 years. Half of these patients required chemotherapy and one-tenth have died. Genomic DNA was extracted from purified CLL cells and buccal cells (BC) collected at diagnosis. Telomere length was established by multiplex quantitative real-time PCR. Telomere/standard (t/s) ratio was calculated using the beta-globulin gene as the standard. Statistical analysis was performed using Statistical Analysis Software (SAS) and Prism software. Results: The median adjusted telomere length was shorter in CLL cells than in BCs being 0.53 and 2.01, respectively. In BCs, telomere length significantly shortened with increasing age (p = 0.01) but was not reflective of the number of comorbidities or survival. In contrast, telomere length in CLL cells was independent of age (p = 0.44) and sex (p = 0.75). Short CLL telomere length correlated with other biological and clinical markers of poorer prognosis including un-mutated IGHV status (p<0.0001), Zap70 positivity (p = 0.05), CD38 positivity (p = 0.003), short lymphocyte doubling time (p = 0.004), higher Rai stage (p = 0.02) and an earlier time to treatment (p<0.0001). Patients with short CLL telomeres had also decreased survival at four years (p = 0.05); living 22 months less than those with normal telomeres. Adjusting for BC telomere length improved the prognostic value of CLL telomere length as an independent predictor of survival. Conclusions: These results demonstrate that BC telomere length in CLL patients shorten with age independent of co-morbidities, secondary malignancies and the respective CLL telomere length. CLL telomere shortening is strongly associated with biochemical and clinical markers of disease progression and survival. The predictive value for overall survival is enhanced by correcting for changes in buccal cell telomere length. Note: This abstract was not presented at the meeting. Citation Format: Lin Yang, Sara Beiggi, Yunli Zhang, Robert Schmidt, Spencer B. Gibson, James B. Johnston. Clinical impact of telomere shortening in normal and leukemia cells in chronic lymphocytic leukemia. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4624. doi:10.1158/1538-7445.AM2015-4624