Department of Communication Sciences & Disorders, University of South Florida, Tampa, Florida, USA.
School of Aging Studies, University of South Florida, Tampa, Florida, USA.
Ear Hear. 2021 July/Aug;42(4):762-771. doi: 10.1097/AUD.0000000000000995.
We sought to determine what factors, including acculturation (language and social contact preferences), were associated with self-perceived hearing handicap among adults from Hispanic/Latino background. We utilized the Aday-Andersen behavioral model of health services utilization to frame our hypotheses that predisposing characteristics (age, sex, education, city of residence, Hispanic/Latino background, and acculturation), enabling resources (annual income and current health insurance coverage), and need (measured hearing loss and self-reported hearing loss) would be related to clinically-significant self-perceived hearing handicap as measured by the Hearing Handicap Inventory - Screening (HHI-S) version.
We analyzed baseline data collected from 2008 to 2011 as part of the multisite Hispanic Community Health Study/Study of Latinos. Data were from 6585 adults with hearing loss (defined by a worse-ear 500, 1000, 2000, and 4000 Hz pure-tone average [PTA] of ≥25 dB HL and/or a 4000, 6000, and 8000 Hz high-frequency PTA of ≥25 dB HL) aged 18 to 74 years from various Hispanic/Latino backgrounds. We conducted a series of multivariable logistic regression models examining the roles of independent variables of interest representing predisposing, enabling, and need indicators on the occurrence of clinically-significant self-perceived hearing handicap (e.g., HHI-S score > 8).
Among included participants, 953 (14.5%) had an HHI-S score >8. The final model revealed significant associations between predisposing characteristics, enabling resources, need, and HHI-S outcome. Predisposing characteristics and need factors were associated with higher odds of reporting self-perceived hearing handicap (HHI-S score >8) including acculturation as measured by the Short Acculturation Scale for Hispanics (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.09-1.50), female sex (OR = 1.72, 95% CI: 1.27-2.33), and poorer worse ear 500, 1000, 2000, and 4000 Hz PTA (OR = 1.02, 95% CI: 1.01-1.03); suggesting that a 5-decibel increase in a person's PTA was consistent with 10% higher odds of a HHI-S score of >8. Greater enabling resources were associated with lower odds of reporting clinically-significant self-perceived hearing handicap: compared with individuals with income <$10,000/year, the multivariable-adjusted OR among individuals with income $40,000 to $7500/year was 0.55 (95% CI: 0.33-0.89) and among individuals with income >$75,000/year was 0.28 (95% CI: 0.13-0.59]; p-trend < 0.0001).
Our findings suggest there are associations between predisposing, enabling and need variables consistent with the Aday-Andersen model and self-perceived hearing handicap among adults from Hispanic/Latino background. The influence of language and culture on perceived hearing loss and associated handicap is complex, and deserves more attention in future studies. Our findings warrant further investigation into understanding the role of language and language access in hearing health care utilization and outcomes, as the current body of literature is small and shows mixed outcomes.
我们旨在确定哪些因素（包括文化适应，包括语言和社会接触偏好）与西班牙裔/拉丁裔背景的成年人的自我感知听力障碍有关。我们利用 Aday-Andersen 行为健康服务利用模型来构建假设，即倾向特征（年龄、性别、教育程度、居住城市、西班牙裔/拉丁裔背景和文化适应）、使能资源（年收入和当前健康保险覆盖范围）以及需要（测量听力损失和自我报告的听力损失）与临床显著的自我感知听力障碍有关，通过听力障碍清单 - 筛选（HHI-S）版本来衡量。
我们分析了 2008 年至 2011 年作为多地点西班牙裔社区健康研究/拉丁裔研究的一部分收集的基线数据。数据来自 6585 名听力损失成年人（定义为较差耳朵 500、1000、2000 和 4000 Hz 纯音平均听力 [PTA] ≥ 25 dB HL 和/或 4000、6000 和 8000 Hz 高频 PTA ≥ 25 dB HL），年龄在 18 至 74 岁之间，来自不同的西班牙裔/拉丁裔背景。我们进行了一系列多变量逻辑回归模型，研究了代表倾向、使能和需求指标的独立变量与临床显著自我感知听力障碍（例如，HHI-S 评分> 8）发生的关系。
在包括的参与者中，有 953 人（14.5%）HHI-S 评分> 8。最终模型显示，倾向特征、使能资源、需求和 HHI-S 结果之间存在显著关联。倾向特征和需求因素与报告自我感知听力障碍（HHI-S 评分> 8）的更高几率相关，包括通过西班牙语短文化适应量表测量的文化适应（比值比[OR] = 1.28，95%置信区间[CI]：1.09-1.50），女性（OR = 1.72，95% CI：1.27-2.33）和较差的较差耳朵 500、1000、2000 和 4000 Hz PTA（OR = 1.02，95% CI：1.01-1.03）；这表明一个人的 PTA 增加 5 分贝，与 HHI-S 评分> 8 的几率增加 10%一致。更多的使能资源与报告临床显著自我感知听力障碍的几率较低相关：与年收入<10,000 美元的个体相比，年收入为 40,000 至 75,000 美元的个体的多变量调整后 OR 为 0.55（95%CI：0.33-0.89），年收入> 75,000 美元的个体为 0.28（95%CI：0.13-0.59）；p-趋势<0.0001）。
我们的研究结果表明，在西班牙裔/拉丁裔背景的成年人中，存在与 Aday-Andersen 模型一致的倾向、使能和需求变量与自我感知听力障碍之间的关联。语言和文化对感知听力损失及其相关障碍的影响是复杂的，值得在未来的研究中给予更多关注。我们的研究结果值得进一步研究，以了解语言和语言获取在听力保健利用和结果方面的作用，因为目前的文献数量较少，结果不一致。
