Prevalence and determinants of hearing impairment among elders in Colombo, Sri Lanka

Introduction: Hearing impairment, the fourth leading cause of disability worldwide, impacts communication and quality of life especially in the elderly. It is defined as inability to hear sound levels above 25dB in pure tone audiometry.  
Objectives: To determine the prevalence of hearing impairment and its demographic and socioeconomic determinants among elderly persons living in the district of Colombo, Sri Lanka 
Methods: A community-based cross-sectional study enrolled 900 elders aged 65 years and above from 36 grama niladhari (GN) divisions. Hearing impairment was assessed using the portable screening audiometry (PSA) test, with positive cases defined as hearing impairment in one or both ears. Other data were collected using an interviewer-administered- questionnaire. Apparent and true prevalences (adjusted for sensitivity & specificity of PSA) were calculated with 95% confidence interval. Bivariate analysis identified the associated factors and muti-variate analysis was utilized to control the effects of confounding factors. 
Results: The apparent prevalence was 52.7% (95% CI: 51.8, 53.5), while true prevalence was 32.8% (95% CI: 27.8, 37.1). Of the affected individuals (n=454), 26.9% (95% CI: 25.1, 27.8) had unilateral impairment and 25.7% (95% CI: 24.8, 26.5) had bilateral impairment. Employment (OR: 1.4; 95% CI: 1.1, 1.9) and education level (OR: 1.6; 95% CI: 1.1, 2.5) were significant predictors in the bivariate analysis. Being male (adjusted OR: 1.4; 95% CI: 1.1, 2.0) and being employed (adjusted OR: 1.4; 95% CI: 1.1, 1.9) showed a higher risk for hearing impairment when controlled for the effect of other factors. 
Conclusions & Recommendations: Hearing impairment is highly prevalent among elders in Sri Lanka, with being employed and being male as key determinants. Community-based screening programmes should focus on groups identified as being at a higher risk of having hearing impairment.