中年人群社区纵向研究中听力损失的变化及其与总体健康的关联：Busselton健康老龄化研究

文献信息

中文摘要

引言： 随着全球人口老龄化，致残性听力损失成为重大健康问题。虽然年龄和性别是已确定的决定因素，但总体健康和环境健康因素与听力损失进展之间的关系仍不完全清楚，尤其是在中年成人中。
方法： 我们使用了Busselton健康老龄化研究（BHAS）的数据，这是一项位于西澳大利亚的基于人群的队列研究。基线（2010-2015年）年龄为45-70岁的成人接受了听力学测试和健康评估，并进行了六年随访。计算了较好耳0.5-4kHz的四频率纯音平均值（4FPTA）和高频（4和8 kHz）纯音平均值（HFPTA）。听力损失根据WHO标准进行分类。分析了人口学、耳部相关、总体健康和环境因素，并使用线性混合模型分析其与听力阈值变化的关系。
结果： 共纳入3596名在基线和随访时具有可靠听力学结果的参与者（基线平均年龄57.9岁，55%为女性）。在6年随访期间，轻度或以上听力损失的患病率从14%增加到26%（4FPTA），从53%增加到71%（HFPTA）。所有年龄类别的阈值均恶化，男性和较高频率的恶化更明显。在单变量模型中，调整年龄和性别后，年龄较大、男性、较高BMI、吸烟、耳鸣、慢性耳部感染、嘈杂工作场所暴露（尤其是不一致或未使用听力保护）、高血压和糖尿病前期与更快的听力下降显著相关。
结论： 在这项针对中年西澳大利亚人的纵向人群研究中，我们证明听力阈值在六年期间显著下降，男性和较高频率的恶化更明显。研究结果表明，中年期听力损失的进展不仅受年龄和性别影响，还受更广泛的代谢和环境健康特征影响。这些结果强调需要未来研究进一步阐明代谢健康、环境暴露与听力结局之间复杂的相互作用。

英文摘要

INTRODUCTION: With the ageing of the global population, disabling hearing loss is a major health concern. While age and sex are established determinants, the relation between general and environmental health factors and the progression of hearing loss remains incompletely understood, particularly in middle-aged adults.
METHODS: We used data from the Busselton Healthy Ageing Study (BHAS), a population-based cohort in Western Australia. Adults aged 45-70 years at baseline (2010-2015) underwent audiometric testing and health assessments with a six-year follow-up. The better-ear four-frequency Pure Tone Averages for 0.5-4kHZ (4FPTA) and for high frequencies (4 & 8 kHz) (HFPTA) were calculated. Hearing loss was classified according to WHO criteria. Demographic, ear-related, general health, and environmental factors were analysed and their association with change in hearing thresholds using linear mixed models.
RESULTS: 3596 participants with reliable audiometry at baseline and follow-up were included (mean baseline age 57.9 years, 55% female). Over 6 years follow-up, the prevalence of mild-or-greater hearing loss increased from 14% to 26% (4FPTA) and from 53% to 71% (HFPTA). Thresholds worsened across all age categories, with greater deterioration in men and at higher frequencies. In univariate models, older age, male sex, higher BMI, smoking, tinnitus, chronic ear infection, noisy workplace exposure (particularly with inconsistent or absent hearing protection), hypertension and pre-diabetes were significantly associated with faster hearing decline after adjustments for age and sex.
CONCLUSIONS: In this longitudinal population-based study of middle-aged Western Australians we demonstrated that hearing thresholds significantly declined over a six-year period with greater deterioration in men and at higher frequencies. Findings suggest that hearing loss progression in midlife is shaped not only by age and sex, but also by broader metabolic and environmental health profiles. These outcomes highlight the need for future research to further clarify the complex interplay between metabolic health, environmental exposures, and hearing outcomes.