Exploring the Link Between Hearing Impairment and Depression in Elderly China

Exploring the Link Between Hearing Impairment and Depression in Elderly China | 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 Exploring the Link Between Hearing Impairment and Depression in Elderly China Bin Sun, Xujia Zhang, Jingyi Xie, Jinyi Tian, Yulu Yan, Jianbin Sun, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7196828/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Hearing impairment (HI) and depression are prevalent among older adults, yet their association remains underexplored in China. This study investigates the link between depressive symptoms and self-reported HI risk using longitudinal data. Methods Data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS) were examined. Following application of inclusion and exclusion criteria, 4,547 participants from CHARLS and 7,390 from CLHLS were enrolled. Self-reported HI was evaluated using the question: “Do you ever wear a hearing aid? Would you say your hearing is excellent, very good, good, fair, or poor?” Subjective HI was defined as any response other than 'excellent' or 'good' to the hearing question, or reported hearing aid use. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CESD), with participants classified into high- and low-depression groups. Severity of depressive symptoms served as the primary exposure variable. Cox regression, restricted cubic splines, time-dependent ROC curves, and population attributable fraction analyses were employed to assess the association between depressive symptoms and HI, with adjustments for confounders. Results Over an extended follow-up, the low CESD group demonstrated a significantly lower risk of HI compared with the high CESD group (p < 0.001). Higher CESD scores were associated with an increased HI risk in both the CHARLS (HR = 1.68, 95% CI = 1.50–1.88) and CLHLS (HR = 1.59, 95% CI = 1.38–1.83) cohorts. A linear association was identified between CESD scores and HI risk in CHARLS (p for association < 0.001; p for nonlinearity = 0.142) and CLHLS (p for association < 0.05; p for nonlinearity = 0.375). In the CLHLS cohort, gender and alcohol consumption significantly influenced the association between depressive symptoms and HI (p for interaction < 0.05). Population attributable fraction analysis revealed that eliminating the high CESD group could prevent 32.68% of HI cases in CHARLS and 29.20% in CLHLS. Conclusions Depressive symptoms are linearly associated with increased risk of self-reported HI. Targeting alcohol consumption and depression management in older adults may be critical for developing HI prevention strategies. Clinical trial number: This is a retrospective cohort study targeting a population survey, which does not involve clinical trials and does not have clinical trial numbers. Hearing impairment Depression Incidence Linear relationship CHARLS CLHLS Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7196828","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510797755,"identity":"06b61328-acab-4127-9548-35131d4dbbc9","order_by":0,"name":"Bin Sun","email":"","orcid":"","institution":"Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Sun","suffix":""},{"id":510797756,"identity":"976e57ff-e69b-4d90-a300-7932f27725d7","order_by":1,"name":"Xujia Zhang","email":"","orcid":"","institution":"Second Affiliated Hospital of Xi'an Jiaotong 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13:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7196828/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7196828/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108610476,"identity":"3880fbb0-94c2-452f-afe7-6aa91ba69a5c","added_by":"auto","created_at":"2026-05-06 12:57:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":818530,"visible":true,"origin":"","legend":"","description":"","filename":"BMCGeriatricsSubmission0808.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7196828/v1_covered_4c6bd563-5898-40bb-b121-4f696bb278dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring the Link Between Hearing Impairment and Depression in Elderly China\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hearing impairment, Depression, Incidence, Linear relationship, CHARLS, CLHLS","lastPublishedDoi":"10.21203/rs.3.rs-7196828/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7196828/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHearing impairment (HI) and depression are prevalent among older adults, yet their association remains underexplored in China. This study investigates the link between depressive symptoms and self-reported HI risk using longitudinal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS) were examined. Following application of inclusion and exclusion criteria, 4,547 participants from CHARLS and 7,390 from CLHLS were enrolled. Self-reported HI was evaluated using the question: “Do you ever wear a hearing aid? Would you say your hearing is excellent, very good, good, fair, or poor?” Subjective HI was defined as any response other than 'excellent' or 'good' to the hearing question, or reported hearing aid use. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CESD), with participants classified into high- and low-depression groups. Severity of depressive symptoms served as the primary exposure variable. Cox regression, restricted cubic splines, time-dependent ROC curves, and population attributable fraction analyses were employed to assess the association between depressive symptoms and HI, with adjustments for confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver an extended follow-up, the low CESD group demonstrated a significantly lower risk of HI compared with the high CESD group (p \u0026lt; 0.001). Higher CESD scores were associated with an increased HI risk in both the CHARLS (HR = 1.68, 95% CI = 1.50–1.88) and CLHLS (HR = 1.59, 95% CI = 1.38–1.83) cohorts. A linear association was identified between CESD scores and HI risk in CHARLS (p for association \u0026lt; 0.001; p for nonlinearity = 0.142) and CLHLS (p for association \u0026lt; 0.05; p for nonlinearity = 0.375). In the CLHLS cohort, gender and alcohol consumption significantly influenced the association between depressive symptoms and HI (p for interaction \u0026lt; 0.05). Population attributable fraction analysis revealed that eliminating the high CESD group could prevent 32.68% of HI cases in CHARLS and 29.20% in CLHLS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepressive symptoms are linearly associated with increased risk of self-reported HI. Targeting alcohol consumption and depression management in older adults may be critical for developing HI prevention strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective cohort study targeting a population survey, which does not involve clinical trials and does not have clinical trial numbers.\u003c/p\u003e","manuscriptTitle":"Exploring the Link Between Hearing Impairment and Depression in Elderly China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 17:37:30","doi":"10.21203/rs.3.rs-7196828/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"309f6259-bcff-4b8e-b328-46ecf8b770bf","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T12:55:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 17:37:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7196828","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7196828","identity":"rs-7196828","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}