Effects of occupation on hearing in older adults: A Sri Lankan perspective

Effects of occupation on hearing in older adults: A Sri Lankan perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of occupation on hearing in older adults: A Sri Lankan perspective Gayani Sandeepika Dissanayake, Nalika Gunawardana, Yasoma Kumari weerasekara, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8568219/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Mar, 2026 Read the published version in BMC Geriatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background Hearing impairment is an important global public health concern and is the fourth leading cause of disability worldwide. Older adults with hearing impairment experience communication difficulties and poor quality of life. By definition, “Hearing impairment” is the inability to hear sound levels between − 10 dB and 25 dB in Pure Tone Audiometry (PTA). This study aimed to determine the occupational factors associated with hearing impairment among older adults aged ≥ 65 years in Colombo, Sri Lanka. Methods A community-based descriptive cross-sectional study was conducted among a representative sample of older adults aged ≥ 65 years (N = 900) selected from households in 36 Grama Niladhari divisions within the Colombo district. Older adults who were cognitively impaired, had symptoms of upper respiratory tract infection (URTI), and had cerumen impaction identified by auroscopic examination were excluded from the study. Hearing impairment was assessed using a validated Portable Screening Audiometer (PSA) test and an interviewer-administered questionnaire to assess occupational factors associated with hearing impairment. Bivariate and multivariable analyses were performed to determine the occupational factors associated with hearing impairment. Results The prevalence of hearing impairment was 52.7% (95% CI: 51.8–53.5), with hearing impairment in one or both ears. Multivariable analysis was used to identify factors associated with hearing impairment. Older adults who reported exposure to noise from loud machines (adjusted OR, 1.86; 95%CI: 1.67–4.08, p = 0.02), exposure to noise from sewing machines (adjusted OR,2.93, 95% CI:1.86–4.26, p = 0.01), and exposure to chemicals such as thinners and cleaning agents for > 6 h/day for 5 years or more (adjusted OR, 1.3,95%CI: 1.8–3.68, p < 0.05) were associated with hearing impairment after controlling for the effects of other factors. Conclusions Work-related factors associated with hearing impairment were interrelated to work exposures and were modifiable with appropriate interventions to reduce exposure. Hearing impairment environmental occupational factors older adults Introduction Age-related hearing loss is a major and growing public health concern worldwide, particularly in low- and middle-income countries, where occupational exposures remain poorly regulated and preventive services are limited ( 1 ). Hearing impairment among older adults adversely affects communication, social participation, and quality of life and is strongly associated with depression, cognitive decline, and functional disability ; ( 2 ). In Sri Lanka, population aging is accelerating, yet hearing health has received limited attention within occupational and geriatric health policy frameworks ( 3 ). Occupational noise exposure is a well-established determinant of occupational hearing impairment. Long-term exposure to high-intensity noise in sectors such as manufacturing, construction, transport, and agriculture leads to cumulative cochlear damage over the life course ( 4 ); ( 5 ). Evidence from high-income countries consistently demonstrates strong associations between prolonged occupational noise exposure and both early onset and severe hearing loss ( 6 ). However, these findings may not be directly generalizable to Sri Lanka because of differences in workplace conditions, regulatory enforcement, use of hearing protection, and access to occupational health services. Studies conducted in Sri Lanka have largely focused on clinic-based populations or single occupational groups, with limited emphasis on older adults and lifetime occupational exposure patterns ( 7 ). Few community-based studies have examined occupation as a determinant of hearing impairment while accounting for age, sex, and comorbidities. This lack of population-level evidence limits the ability to design effective occupational hearing conservation and healthy aging strategies. Therefore, a clear research gap exists in understanding how different occupational categories influence the hearing status of older adults in Sri Lanka. This study aimed to assess the association between occupational history and hearing impairment among older adults and to identify occupation-related patterns of hearing loss within a Sri Lankan community setting. Methods This study employed a descriptive cross-sectional design conducted among community dwelling older adults in Sri Lanka, in accordance with STROBE recommendations for observational studies ( 8 ). The study setting was selected to capture participants from diverse occupational backgrounds, including manual and non-manual employment. The study population consisted of adults aged ≥ 65 years. The eligibility criteria included residency within the study area for the specified period and provision of informed consent. Individuals with acute ear infections or congenital hearing disorders were excluded to reduce potential confounding factors. Sampling and sample size Participants were selected using the sampling approach described in the original study’s protocol. Sample size estimation was informed by the previously reported prevalence of hearing impairment in older populations, with allowance for non-response. The prevalence of hearing impairment was set at 0.57, based on evidence from India ( 9 ). A margin of error of 0.05 was considered for calculations. Considering a 15% non-response rate, the final sample size was calculated as 900 after rounding off. Two-stage cluster sampling was employed to select 36 clusters from the six DS divisions. Data were collected by three trained pre-intern medical officers using a validated PSA test to determine the presence of hearing impairment. A sound level of 60 dB was identified as the cutoff value for the PSA test ( 10 ). The PSA was administered prior to administering the interviewer-administered questionnaire (IAQ) by a designated data collector trained to perform the procedure. The IAQ consisted of basic sociodemographic and socioeconomic information and questions with details of the history of exposure to occupational factors that can be associated with hearing impairment. The interviewer-administered questionnaire used for this study was developed by the principal investigator. An English-language version is uploaded as Supplementary File 1. The training consisted of mock sessions to ensure the uniform administration of the IAQ. This measure was implemented to minimize interviewer variation. Hearing status was the primary outcome variable and was assessed using standardized audiological assessment methods that aligned with international guidelines ( 11 ). Hearing impairment was categorized based on established, validated portable screening audiometry thresholds. Occupational exposure was classified according to the longest-held occupation, grouped by presumed noise exposure risk, consistent with prior occupational epidemiology studies ( 12 ). Sociodemographic variables included age, sex, education level, and socioeconomic status. Health-related variables included self-reported chronic conditions known to influence hearing, such as diabetes ( 13 ) and hypertension ( 14 ). Data collection procedure and analysis Data collection involved interviewer-administered questionnaires combined with objective hearing assessments. Data collectors were trained to follow standardized protocols to ensure measurement consistency and to minimize interviewer bias. Data analysis was performed using appropriate statistical software. Descriptive statistics were used to summarize the participant characteristics and hearing status. Associations between occupational categories and hearing impairment were examined using inferential statistical methods, adjusting for key covariates, as specified in the original analysis plan. Statistical significance was assessed using a predefined threshold. Multivariable logistic regression was used to control for confounding factors in identifying the factors associated with hearing impairment. All variables in the multivariate analysis were categorical. When performing the analysis, the variables with a significance of 0.2 in the bivariate analysis were entered into the model for multivariable analysis. Results Of the 900 participants recruited, 862 completed the study contributing to response rate of the 95.8%. The socio-demographic and socio-economic details of the sample are presented in Table 1 . The majority of the respondents were in the age category of 65–69 years and were females (n = 504,58.5%) (40.5%, n = 349). The mean age of the sample was 72.4 (SD = ± 6.1) years, and the median was 71.6 years. Most of the study sample (n = 774, 89.8%) had completed education up to grade 10. The great majority (n = 794,92.1%) were of Sinhalese ethnicity, and 741(86%) were Buddhists. Among the participants, the majority (n = 572, 66.4%) were married, and most (n = 781, 90.6%) lived with children or others. The majority (n = 595,69%) were unemployed at the time of the survey. Almost three-fourths (n = 649,75.2%) reported a monthly income of < 20,000 Rupees or no income. Table 1 Sociodemographic/economic characteristics of the study sample Characteristic Number(n = 862) Percentage (%) Age categories (In completed years) 65–69 years 349 40.5 70–74 years 231 26.8 75 and more 75 years 282 32.7 Sex Male 358 41.5 Female 504 58.5 Highest education level Educated up to grade 10 774 89.8 Educated above grade 10 88 10.2 Ethnicity Sinhalese 794 92.1 Other 68 7.9 Religion Buddhism 741 86.0 Other 121 14.0 Marital status Married 572 66.4 Other 290 33.6 Living Status Living alone 81 9.4 Living with others 781 90.6 Employment status Unemployed 595 69.0 Employed 267 31.0 Average income per month None 357 41.4 20,000 Rupees 213 24.7 Insert Table 1 here - Table 1 : Sociodemographic/economic characteristics of the study sample A person with hearing impairment was defined in the present study as a person who could not hear in one or both ears at the 60 dB level of the PSA test. The prevalence of hearing impairment among older adults was 52.7% (454), 95% CI:51.8–53.5. Work exposure to sewing machines (adjusted OR, 2.93; 95% CI:1.86–4.26, p = 0.01), loud machines (adjusted OR, 1.86; 95% CI:1.67–4.08, p = 0.02), work exposure to metal product manufacturing environment (adjusted OR, 3.10; 95% CI:1.45–6.62, p 6 h/day for 5 years or more (adjusted OR,1.96, 95% CI: 1.08–3.68, p = 0.04) at the time of the survey showed a higher risk of hearing impairment among older adults when controlled for the effect of other factors (Table 2 ). Table 2 Results of the multivariable logistic regression analysis Characteristic Unadjusted 95% CI Adjusted 95% CI OR Lower Upper P value OR Lower Upper P value Being male 1.0 0.8 1.3 0.80 1.8 1.4 5.3 0.03 Being employed 1.4 1.0 1.4 0.00 1.3 1.1 3.4 0.03 Work exposure to sewing machines 0.7 0.5 1.1 0.10 2.9 1.9 4.3 0.01 Work exposure to loud machines 1.1 0.7 1.5 0.80 1.9 1.7 4.1 0.02 Work exposure to metal product manufacturing environment 4.6 1.0 4.6 0.05 3.1 1.5 6.6 6 hours/day for 5 years or more 1.7 1.1 2.7 0.02 2.0 1.1 3.7 0.04 Work exposure to fiber glass 0.7 0.3 3.4 0.10 0.9 0.3 2.4 0.80 Insert Table 1 here - Table 2 : Results of the multivariable logistic regression analysis Discussion This study demonstrated a clear association between occupational history and hearing impairment among older adults in Sri Lanka, reinforcing the role of cumulative workplace exposure in shaping auditory health in later life. The higher prevalence and severity of hearing loss among participants from noise-intensive and manual occupations suggests that occupational factors contribute independently to age-related auditory decline, beyond physiological aging alone. These findings are consistent with life course models of hearing loss, which emphasize the accumulation of environmental and occupational insults over decades of exposure ( 6 );( 15 ). The observed occupational gradient in hearing impairment aligns with international evidence showing that long-term exposure to hazardous noise levels accelerates cochlear degeneration and exacerbates presbycusis ( 4 ); ( 5 ). However, the magnitude of hearing impairment in this population appears to be greater than that reported in many high-income settings. This difference likely reflects contextual factors such as the limited enforcement of occupational noise standards, low availability and inconsistent use of personal hearing protection, and minimal routine audiological surveillance in Sri Lankan workplaces ( 1 ). Unlike many studies that focus on currently employed workers, this study highlights the lasting effects of occupational exposure after retirement. This is particularly relevant in low- and middle-income countries, where individuals often remain in high-risk occupations for prolonged periods without adequate protection and continue working into older age due to economic necessity ( 16 ). Consequently, occupationally related hearing damage may remain undetected and unmanaged until it manifests as significant functional impairment in later life. The findings also underscore the important social and occupational inequities in hearing health. Older adults from manual labor backgrounds, who are more likely to belong to lower socioeconomic groups, appear to be disproportionately affected. Hearing impairment may compound existing disadvantages by limiting social participation, access to health services, and economic opportunities, thereby reinforcing health inequalities in older age ( 17 );( 2 ). This intersection between occupation, aging, and sensory impairment warrants greater attention in public health planning. From a methodological perspective, the community-based design of this study strengthens the generalizability of the findings beyond clinical settings. The focus on the longest-held occupation provides a pragmatic proxy for lifetime occupational exposure, which has been recommended in occupational epidemiology when direct exposure measurements are unavailable ( 18 ). However, this approach may still underestimate the variability in exposure intensity and duration within occupational categories. Several limitations should be considered when interpreting the results. Occupational history was self-reported, introducing potential recall bias, particularly in older participants. Misclassification of occupational noise exposure is also possible because job titles may not fully capture the actual noise levels experienced. Additionally, the cross-sectional design precludes causal inference, and reverse causation cannot be excluded entirely. Residual confounding from non-occupational noise sources, such as environmental or recreational exposure, may also influence these associations ( 19 ). Despite these limitations, our findings have clear implications for occupational and public health policies. The persistence of occupation-related hearing loss into older age highlights the need for stronger preventive strategies across the working life. The enforcement of occupational noise regulations, mandatory use of hearing protection in high-risk sectors, and regular workplace hearing assessments could substantially reduce cumulative auditory damage ( 20 ). Importantly, these measures should extend beyond formal employment settings to include informal and agricultural sectors, which are often underregulated. The integration of hearing screening into primary care and geriatric health services is also critical. Early identification and management of hearing impairment may mitigate downstream consequences, such as social isolation, depression, and cognitive decline, which have been increasingly linked to untreated hearing loss in older adults ( 6 );( 2 ). Therefore, addressing hearing health should be viewed as part of broader healthy aging strategies rather than an isolated clinical issue. Future research should adopt longitudinal designs to clarify the temporal relationship between occupational exposure and hearing decline. Studies incorporating objective noise exposure measurements, detailed work histories, and repeated audiological assessments would strengthen the causal inference. Intervention studies evaluating the effectiveness of occupational hearing conservation programs in low- and middle-income settings are also needed to guide context-specific policy development ( 5 ); ( 21 ); ( 18 ). Conclusions and recommendations Most factors associated with hearing impairment were related to work exposure and were modifiable with appropriate interventions to reduce exposure. Appropriate interventions are recommended to mitigate identified occupational risks and should be used as pointers to evaluate the need to refer such individuals for screening of hearing impairment. Encouraging employees to use personal protective equipment, such as goggles and ear muffles, is one strategy that could be implemented. Some occupational factors are modifiable with appropriate interventions to reduce the emission of hazardous products. Public Health Implications : With demographic transition, an increasing trend has been observed in the prevalence of hearing impairment among older adults, which could be an arena of newly emerging public health concern. Of the factors associated with hearing impairment, occupational factors could be considered modifiable factors that can be addressed with tailor-made interventions. Abbreviations PTA – Pure Tone Audiometry URTI – Upper Respiratory Tract Infection PSA – Portable Screening Audiometer CI – Confidence Interval STROBE – Strengthening the Reporting of Observational Studies in Epidemiology IAQ – Interviewer Administered Questionnaire SD – Standard Deviation OR – Odds Ratio ENT – Ear, Nose and Throat Declarations Ethics approval and consent to participate All methods used in this study were performed in accordance with the ethical principles of the Declaration of Helsinki for medical research involving human subjects. Ethics approval for this study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (reference number: EC-22-032). Prior to conducting the study, permission was obtained from the Provincial Director of Health Service Western Province, Regional Director of Health, Colombo, District Secretary Colombo, and Divisional Secretaries in Colombo. Written informed consent was obtained from all participants. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Competing interests: The authors declare that they have no competing interests Funding : Self-funded Authors’ contributions: GSD served as the principal investigator for the research, while NG and YKW provided invaluable contributions as the technical supervisors of the entire project, reviewed, and finalized the manuscript. SDW guided and reviewed the manuscript. CJ provided guidance for tool development and implementation of data collection. Acknowledgements: The principal investigator extends sincere thanks to the research supervisors, the Consultant ENT surgeon at the National Hospital of Sri Lanka, and to all the study participants and data collectors for their valuable contributions . References World Health Organization. World Report on Hearing [Internet]. 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Supplementary Files OccupationalIAQ17.01.2026.pdf Cite Share Download PDF Status: Published Journal Publication published 20 Mar, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 24 Feb, 2026 Reviews received at journal 23 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviews received at journal 28 Jan, 2026 Reviewers agreed at journal 24 Jan, 2026 Reviewers invited by journal 19 Jan, 2026 Editor assigned by journal 19 Jan, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 17 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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16:12:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":651285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8568219/v1/5efc3635-03b9-445e-924b-78eb370c46dc.pdf"},{"id":100858347,"identity":"eb46e454-0719-4df2-bfbc-bb065cdde09c","added_by":"auto","created_at":"2026-01-22 07:24:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":169206,"visible":true,"origin":"","legend":"","description":"","filename":"OccupationalIAQ17.01.2026.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8568219/v1/128d8d30f008494a81af509e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of occupation on hearing in older adults: A Sri Lankan perspective","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAge-related hearing loss is a major and growing public health concern worldwide, particularly in low- and middle-income countries, where occupational exposures remain poorly regulated and preventive services are limited (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Hearing impairment among older adults adversely affects communication, social participation, and quality of life and is strongly associated with depression, cognitive decline, and functional disability ; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Sri Lanka, population aging is accelerating, yet hearing health has received limited attention within occupational and geriatric health policy frameworks (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOccupational noise exposure is a well-established determinant of occupational hearing impairment. Long-term exposure to high-intensity noise in sectors such as manufacturing, construction, transport, and agriculture leads to cumulative cochlear damage over the life course (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e); (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Evidence from high-income countries consistently demonstrates strong associations between prolonged occupational noise exposure and both early onset and severe hearing loss (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, these findings may not be directly generalizable to Sri Lanka because of differences in workplace conditions, regulatory enforcement, use of hearing protection, and access to occupational health services.\u003c/p\u003e \u003cp\u003eStudies conducted in Sri Lanka have largely focused on clinic-based populations or single occupational groups, with limited emphasis on older adults and lifetime occupational exposure patterns (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Few community-based studies have examined occupation as a determinant of hearing impairment while accounting for age, sex, and comorbidities. This lack of population-level evidence limits the ability to design effective occupational hearing conservation and healthy aging strategies. Therefore, a clear research gap exists in understanding how different occupational categories influence the hearing status of older adults in Sri Lanka. This study aimed to assess the association between occupational history and hearing impairment among older adults and to identify occupation-related patterns of hearing loss within a Sri Lankan community setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employed a descriptive cross-sectional design conducted among community dwelling older adults in Sri Lanka, in accordance with STROBE recommendations for observational studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The study setting was selected to capture participants from diverse occupational backgrounds, including manual and non-manual employment. The study population consisted of adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years. The eligibility criteria included residency within the study area for the specified period and provision of informed consent. Individuals with acute ear infections or congenital hearing disorders were excluded to reduce potential confounding factors.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSampling and sample size\u003c/h2\u003e \u003cp\u003eParticipants were selected using the sampling approach described in the original study\u0026rsquo;s protocol. Sample size estimation was informed by the previously reported prevalence of hearing impairment in older populations, with allowance for non-response. The prevalence of hearing impairment was set at 0.57, based on evidence from India (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A margin of error of 0.05 was considered for calculations. Considering a 15% non-response rate, the final sample size was calculated as 900 after rounding off. Two-stage cluster sampling was employed to select 36 clusters from the six DS divisions. Data were collected by three trained pre-intern medical officers using a validated PSA test to determine the presence of hearing impairment. A sound level of 60 dB was identified as the cutoff value for the PSA test (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The PSA was administered prior to administering the interviewer-administered questionnaire (IAQ) by a designated data collector trained to perform the procedure. The IAQ consisted of basic sociodemographic and socioeconomic information and questions with details of the history of exposure to occupational factors that can be associated with hearing impairment. The interviewer-administered questionnaire used for this study was developed by the principal investigator. An English-language version is uploaded as Supplementary File 1. The training consisted of mock sessions to ensure the uniform administration of the IAQ. This measure was implemented to minimize interviewer variation.\u003c/p\u003e \u003cp\u003eHearing status was the primary outcome variable and was assessed using standardized audiological assessment methods that aligned with international guidelines (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Hearing impairment was categorized based on established, validated portable screening audiometry thresholds. Occupational exposure was classified according to the longest-held occupation, grouped by presumed noise exposure risk, consistent with prior occupational epidemiology studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Sociodemographic variables included age, sex, education level, and socioeconomic status. Health-related variables included self-reported chronic conditions known to influence hearing, such as diabetes (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and hypertension (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection procedure and analysis\u003c/h3\u003e\n\u003cp\u003eData collection involved interviewer-administered questionnaires combined with objective hearing assessments. Data collectors were trained to follow standardized protocols to ensure measurement consistency and to minimize interviewer bias. Data analysis was performed using appropriate statistical software. Descriptive statistics were used to summarize the participant characteristics and hearing status. Associations between occupational categories and hearing impairment were examined using inferential statistical methods, adjusting for key covariates, as specified in the original analysis plan. Statistical significance was assessed using a predefined threshold. Multivariable logistic regression was used to control for confounding factors in identifying the factors associated with hearing impairment. All variables in the multivariate analysis were categorical. When performing the analysis, the variables with a significance of 0.2 in the bivariate analysis were entered into the model for multivariable analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 900 participants recruited, 862 completed the study contributing to response rate of the 95.8%. The socio-demographic and socio-economic details of the sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of the respondents were in the age category of 65\u0026ndash;69 years and were females (n\u0026thinsp;=\u0026thinsp;504,58.5%) (40.5%, n\u0026thinsp;=\u0026thinsp;349). The mean age of the sample was 72.4 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1) years, and the median was 71.6 years. Most of the study sample (n\u0026thinsp;=\u0026thinsp;774, 89.8%) had completed education up to grade 10. The great majority (n\u0026thinsp;=\u0026thinsp;794,92.1%) were of Sinhalese ethnicity, and 741(86%) were Buddhists. Among the participants, the majority (n\u0026thinsp;=\u0026thinsp;572, 66.4%) were married, and most (n\u0026thinsp;=\u0026thinsp;781, 90.6%) lived with children or others. The majority (n\u0026thinsp;=\u0026thinsp;595,69%) were unemployed at the time of the survey. Almost three-fourths (n\u0026thinsp;=\u0026thinsp;649,75.2%) reported a monthly income of \u0026lt;\u0026thinsp;20,000 Rupees or no income.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic/economic characteristics of the study sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber(n\u0026thinsp;=\u0026thinsp;862)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003cp\u003e(In completed years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026ndash;69 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;74 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 and more 75 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducated up to grade 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducated above grade 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSinhalese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuddhism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving with others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage income per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20,000 Rupees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20,000 Rupees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInsert Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here - Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Sociodemographic/economic characteristics of the study sample\u003c/p\u003e \u003cp\u003eA person with hearing impairment was defined in the present study as a person who could not hear in one or both ears at the 60 dB level of the PSA test. The prevalence of hearing impairment among older adults was 52.7% (454), 95% CI:51.8\u0026ndash;53.5.\u003c/p\u003e \u003cp\u003eWork exposure to sewing machines (adjusted OR, 2.93; 95% CI:1.86\u0026ndash;4.26, p\u0026thinsp;=\u0026thinsp;0.01), loud machines (adjusted OR, 1.86; 95% CI:1.67\u0026ndash;4.08, p\u0026thinsp;=\u0026thinsp;0.02), work exposure to metal product manufacturing environment (adjusted OR, 3.10; 95% CI:1.45\u0026ndash;6.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and chemicals (thinner, floor/tile cleaners) for \u0026gt;\u0026thinsp;6 h/day for 5 years or more (adjusted OR,1.96, 95% CI: 1.08\u0026ndash;3.68, p\u0026thinsp;=\u0026thinsp;0.04) at the time of the survey showed a higher risk of hearing impairment among older adults when controlled for the effect of other factors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the multivariable logistic regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeing male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeing employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to sewing machines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to loud machines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to metal product manufacturing environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDriving heavy vehicle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to heavy traffic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to chemicals (thinner, floor/tile cleaners) for \u0026gt;\u0026thinsp;6 hours/day for 5 years or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork exposure to fiber glass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInsert Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here - Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Results of the multivariable logistic regression analysis\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated a clear association between occupational history and hearing impairment among older adults in Sri Lanka, reinforcing the role of cumulative workplace exposure in shaping auditory health in later life. The higher prevalence and severity of hearing loss among participants from noise-intensive and manual occupations suggests that occupational factors contribute independently to age-related auditory decline, beyond physiological aging alone. These findings are consistent with life course models of hearing loss, which emphasize the accumulation of environmental and occupational insults over decades of exposure (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e);(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe observed occupational gradient in hearing impairment aligns with international evidence showing that long-term exposure to hazardous noise levels accelerates cochlear degeneration and exacerbates presbycusis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e); (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, the magnitude of hearing impairment in this population appears to be greater than that reported in many high-income settings. This difference likely reflects contextual factors such as the limited enforcement of occupational noise standards, low availability and inconsistent use of personal hearing protection, and minimal routine audiological surveillance in Sri Lankan workplaces (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnlike many studies that focus on currently employed workers, this study highlights the lasting effects of occupational exposure after retirement. This is particularly relevant in low- and middle-income countries, where individuals often remain in high-risk occupations for prolonged periods without adequate protection and continue working into older age due to economic necessity (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Consequently, occupationally related hearing damage may remain undetected and unmanaged until it manifests as significant functional impairment in later life.\u003c/p\u003e \u003cp\u003eThe findings also underscore the important social and occupational inequities in hearing health. Older adults from manual labor backgrounds, who are more likely to belong to lower socioeconomic groups, appear to be disproportionately affected. Hearing impairment may compound existing disadvantages by limiting social participation, access to health services, and economic opportunities, thereby reinforcing health inequalities in older age (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e);(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This intersection between occupation, aging, and sensory impairment warrants greater attention in public health planning.\u003c/p\u003e \u003cp\u003eFrom a methodological perspective, the community-based design of this study strengthens the generalizability of the findings beyond clinical settings. The focus on the longest-held occupation provides a pragmatic proxy for lifetime occupational exposure, which has been recommended in occupational epidemiology when direct exposure measurements are unavailable (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, this approach may still underestimate the variability in exposure intensity and duration within occupational categories.\u003c/p\u003e \u003cp\u003eSeveral limitations should be considered when interpreting the results. Occupational history was self-reported, introducing potential recall bias, particularly in older participants. Misclassification of occupational noise exposure is also possible because job titles may not fully capture the actual noise levels experienced. Additionally, the cross-sectional design precludes causal inference, and reverse causation cannot be excluded entirely. Residual confounding from non-occupational noise sources, such as environmental or recreational exposure, may also influence these associations (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these limitations, our findings have clear implications for occupational and public health policies. The persistence of occupation-related hearing loss into older age highlights the need for stronger preventive strategies across the working life. The enforcement of occupational noise regulations, mandatory use of hearing protection in high-risk sectors, and regular workplace hearing assessments could substantially reduce cumulative auditory damage (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Importantly, these measures should extend beyond formal employment settings to include informal and agricultural sectors, which are often underregulated.\u003c/p\u003e \u003cp\u003eThe integration of hearing screening into primary care and geriatric health services is also critical. Early identification and management of hearing impairment may mitigate downstream consequences, such as social isolation, depression, and cognitive decline, which have been increasingly linked to untreated hearing loss in older adults (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e);(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Therefore, addressing hearing health should be viewed as part of broader healthy aging strategies rather than an isolated clinical issue.\u003c/p\u003e \u003cp\u003eFuture research should adopt longitudinal designs to clarify the temporal relationship between occupational exposure and hearing decline. Studies incorporating objective noise exposure measurements, detailed work histories, and repeated audiological assessments would strengthen the causal inference. Intervention studies evaluating the effectiveness of occupational hearing conservation programs in low- and middle-income settings are also needed to guide context-specific policy development (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e); (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e); (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eMost factors associated with hearing impairment were related to work exposure and were modifiable with appropriate interventions to reduce exposure. Appropriate interventions are recommended to mitigate identified occupational risks and should be used as pointers to evaluate the need to refer such individuals for screening of hearing impairment. Encouraging employees to use personal protective equipment, such as goggles and ear muffles, is one strategy that could be implemented. Some occupational factors are modifiable with appropriate interventions to reduce the emission of hazardous products.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003ePublic Health Implications\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eWith demographic transition, an increasing trend has been observed in the prevalence of hearing impairment among older adults, which could be an arena of newly emerging public health concern. Of the factors associated with hearing impairment, occupational factors could be considered modifiable factors that can be addressed with tailor-made interventions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePTA\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePure Tone Audiometry\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eURTI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eUpper Respiratory Tract Infection\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePSA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePortable Screening Audiometer\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eConfidence Interval\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSTROBE\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIAQ\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eInterviewer Administered Questionnaire\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eStandard Deviation\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eOdds Ratio\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eENT\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eEar, Nose and Throat\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods used in this study were performed in accordance with the ethical principles of the Declaration of Helsinki for medical research involving human subjects.\u0026nbsp;Ethics approval for this study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (reference number: EC-22-032). Prior to conducting the study, permission was obtained from the Provincial Director of Health Service Western Province, Regional Director of Health, Colombo, District Secretary Colombo, and Divisional Secretaries in Colombo. Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003eCompeting interests: The\u0026nbsp;authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Self-funded\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e GSD served as the principal investigator for the research, while NG and YKW provided invaluable contributions as the technical supervisors of the entire project, reviewed, and finalized the manuscript. SDW guided and reviewed the manuscript. CJ provided guidance for tool development and implementation of data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u0026nbsp; The principal investigator extends sincere thanks to the research supervisors, the Consultant ENT surgeon at the National Hospital of Sri Lanka, and to all the study participants and data collectors for their valuable contributions\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World Report on Hearing [Internet]. Geneva: World Health Organization. 2021. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK543714/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK543714/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRantanen T. Work as Active Aging. In: Rantanen T, editor. Advancing Research on Active Aging and Participation: A Public Health Approach [Internet]. Cham: Springer Nature Switzerland; 2025 [cited 2025 Dec 24]. pp. 129\u0026ndash;42. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-031-94702-5_10\u003c/span\u003e\u003cspan address=\"10.1007/978-3-031-94702-5_10\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarmot M. Social determinants of health inequalities. Lancet Lond Engl. 2005;365(9464):1099\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited States Environment Protection Agency. Guidelines for Human Exposure Assessment Risk Assessment Forum. Vol. 19/001. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgrawal Y, Niparko JK, Dobie RA. Estimating the effect of occupational noise exposure on hearing thresholds: the importance of adjusting for confounding variables. Ear Hear. 2010;31(2):234\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuente A, Hickson L. Noise-induced hearing loss in Asia. Int J Audiol. 2011;50(Suppl 1):S3\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise-induced hearing loss. Cochrane Work Group, editor. Cochrane Database Syst Rev [Internet]. 2017 July 7 [cited 2025 Dec 23];2019(1). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.wiley.com/10.1002/14651858.CD006396.pub4\u003c/span\u003e\u003cspan address=\"http://doi.wiley.com/10.1002/14651858.CD006396.pub4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hearing impairment, environmental, occupational factors, older adults","lastPublishedDoi":"10.21203/rs.3.rs-8568219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8568219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHearing impairment is an important global public health concern and is the fourth leading cause of disability worldwide. Older adults with hearing impairment experience communication difficulties and poor quality of life. By definition, \u0026ldquo;Hearing impairment\u0026rdquo; is the inability to hear sound levels between \u0026minus;\u0026thinsp;10 dB and 25 dB in Pure Tone Audiometry (PTA). This study aimed to determine the occupational factors associated with hearing impairment among older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years in Colombo, Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based descriptive cross-sectional study was conducted among a representative sample of older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years (N\u0026thinsp;=\u0026thinsp;900) selected from households in 36 Grama Niladhari divisions within the Colombo district. Older adults who were cognitively impaired, had symptoms of upper respiratory tract infection (URTI), and had cerumen impaction identified by auroscopic examination were excluded from the study. Hearing impairment was assessed using a validated Portable Screening Audiometer (PSA) test and an interviewer-administered questionnaire to assess occupational factors associated with hearing impairment. Bivariate and multivariable analyses were performed to determine the occupational factors associated with hearing impairment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of hearing impairment was 52.7% (95% CI: 51.8\u0026ndash;53.5), with hearing impairment in one or both ears. Multivariable analysis was used to identify factors associated with hearing impairment. Older adults who reported exposure to noise from loud machines (adjusted OR, 1.86; 95%CI: 1.67\u0026ndash;4.08, p\u0026thinsp;=\u0026thinsp;0.02), exposure to noise from sewing machines (adjusted OR,2.93, 95% CI:1.86\u0026ndash;4.26, p\u0026thinsp;=\u0026thinsp;0.01), and exposure to chemicals such as thinners and cleaning agents for \u0026gt;\u0026thinsp;6 h/day for 5 years or more (adjusted OR, 1.3,95%CI: 1.8\u0026ndash;3.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were associated with hearing impairment after controlling for the effects of other factors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWork-related factors associated with hearing impairment were interrelated to work exposures and were modifiable with appropriate interventions to reduce exposure.\u003c/p\u003e","manuscriptTitle":"Effects of occupation on hearing in older adults: A Sri Lankan perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-21 17:28:58","doi":"10.21203/rs.3.rs-8568219/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T11:50:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T21:55:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151505825765630217591818284247993521597","date":"2026-02-18T19:25:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-28T08:27:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298062199496533309096627761653858462898","date":"2026-01-24T15:21:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-19T13:53:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T13:50:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T08:46:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-17T07:28:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-01-17T07:22:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"feb43584-f638-4654-a081-9a3dc691153b","owner":[],"postedDate":"January 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:08:57+00:00","versionOfRecord":{"articleIdentity":"rs-8568219","link":"https://doi.org/10.1186/s12877-026-07363-4","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-03-20 15:59:12","publishedOnDateReadable":"March 20th, 2026"},"versionCreatedAt":"2026-01-21 17:28:58","video":"","vorDoi":"10.1186/s12877-026-07363-4","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07363-4","workflowStages":[]},"version":"v1","identity":"rs-8568219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8568219","identity":"rs-8568219","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}