Phanguphangu Mukovhe, Ross Andrew John, Smythe Tracey
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa.
PLOS Glob Public Health. 2025 Jun 24;5(6):e0004790. doi: 10.1371/journal.pgph.0004790. eCollection 2025.
Globally, 34 million children below 15 years have hearing loss (HL) and while research shows associations between social determinants of health and disability in general, research on the associations between these determinants and HL in children is limited. Therefore, this study sought to examine the association between social determinants of health and HL in children using the parental socioeconomic status, such as educational attainment level, employment status and income level, non-medical determinants of health (rurality, housing, type of toilet, availability of piped drinking water, and exposure to cigarette smoke) as proxy factors for social determinants of health in children. This was a secondary data analysis of a cross-sectional survey conducted with 517 children in South Africa. We conducted multivariable logistic regression to test for the association between HL and exposure variables such as non-medical determinants of health and parental socioeconomic status using Stata v18 for Macintosh. Odds ratios (OR) with 95% confidence intervals (CIs) were used to ascertain the odds of HL with exposure variables. One hundred and two participants (n = 102, 19.7%) had HL, including 57 (55.9%) females. Crude analysis showed increased odds of HL in females (OR:1.6; 95%CI: 1.0 - 2.5, P = 0.03) and children younger than9 years (OR: 2.0; 95%CI: 1.3 - 3.1, P = 0.003). After adjusting for age and sex, exposure to cigarette smoke (aOR: 4.0; 95%CI:2.4 - 6.4, P < 0.001), living in a mud house (aOR: 1.6; 95%CI:1.2 - 2.7, P = 0.04), lack of piped drinking water (aOR: 1.9; 95%CI:1.1 - 3.1, P < 0.02), using pit latrines (aOR: 4.1; 95%CI:1.3 - 13.0, P = 0.01), having parents who (i) did not complete high school (aOR: 2.8; 95%CI:1.4 - 2.4, P = 0.01), or those earning a combined annual household income (iii) less than $2,882 (aOR: 6.2; 95%CI:2.1 - 51.1, P = 0.03) or (iv) between $2,883 and $8,006 (aOR:5.0; 95%CI:2.5 - 43.5, P = 0.05) increased the odds of HL. Based on these findings, we recommend public health interventions targeting these social determinants to reduce the global burden of HL, and further research to understand the pathophysiology of HL in those exposed to smoking or using pit latrines.
全球范围内，有3400万15岁以下儿童患有听力损失（HL）。虽然研究表明健康的社会决定因素与一般残疾之间存在关联，但关于这些决定因素与儿童HL之间关联的研究却很有限。因此，本研究旨在利用父母的社会经济地位，如教育程度、就业状况和收入水平，以及健康的非医学决定因素（农村地区、住房、厕所类型、管道饮用水供应情况以及接触香烟烟雾情况）作为儿童健康社会决定因素的替代因素，来研究儿童健康的社会决定因素与HL之间的关联。这是对在南非对517名儿童进行的横断面调查的二次数据分析。我们使用适用于Macintosh的Stata v18进行多变量逻辑回归，以检验HL与诸如健康的非医学决定因素和父母社会经济地位等暴露变量之间的关联。使用95%置信区间（CI）的比值比（OR）来确定暴露变量与HL的关联几率。102名参与者（n = 102，19.7%）患有HL，其中包括57名（55.9%）女性。粗分析显示女性（OR：1.6；95%CI：1.0 - 2.5，P = 0.03）和9岁以下儿童（OR：2.0；95%CI：1.3 - 3.1，P = 0.003）患HL的几率增加。在对年龄和性别进行调整后，接触香烟烟雾（调整后OR：4.0；95%CI：2.4 - 6.4，P <0.001）、居住在泥屋（调整后OR：1.6；95%CI：1.2 - 2.7, P = 0.04）、缺乏管道饮用水（调整后OR：1.9；95%CI：1.1 - 3.1，P <0.02）、使用坑式厕所（调整后OR：4.1；95%CI：1.3 - 13.0，P = 0.01）、父母（i）未完成高中学业（调整后OR：2.8；95%CI：1.4 - 2.4，P = 0.01）或家庭年总收入（iii）低于2882美元（调整后OR：6.2；95%CI：2.1 - 51.1，P = 0.03）或（iv）在2883美元至8006美元之间（调整后OR：5.0；95%CI：2.5 - 43.5，P = 0.05）会增加患HL的几率。基于这些发现，我们建议针对这些社会决定因素开展公共卫生干预措施，以减轻全球HL负担，并开展进一步研究以了解接触吸烟或使用坑式厕所人群中HL的病理生理学。
