Economic and Social Determinants of Hearing Aid Acquisition and Utilization: Insights From High- and Middle-Income Countries
Author(s)
Nyasha Makaruse, MPH1, Yehuda Neumark, PhD2, Shuli Brammli-Greenberg, PhD2.
1Hadassah Braun School of Public Health and Community Medicine,, The Hebrew University, Jerusalem, Israel, 2The Hebrew University, Jerusalem, Israel.
1Hadassah Braun School of Public Health and Community Medicine,, The Hebrew University, Jerusalem, Israel, 2The Hebrew University, Jerusalem, Israel.
OBJECTIVES: This study explores the associations between hearing aid acquisition and utilization and country-level determinants in high- and middle-income countries.
METHODS: Data about 28 countries that participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) were sourced from SHARE Wave 9 (2024), EFHOH 2022 report, and OECD Health Statistics Library. Linear regression models assessed the associations between country-level hearing aid acquisition and utilization rates and macro-level predictors including referral route, government health expenditure (GHE), out-of-pocket (OOP) payments, and waiting times. A composite index integrating these explanatory factors was constructed to assess their combined influence. Additionally, logistic regression models analyzed individual-level associations with hearing aid acquisition and utilization.
RESULTS: Hearing aid acquisition rates ranged from 5% to 45%, with Northern Europe exhibiting the highest rates and Eastern Europe the lowest. Among hearing aid owners, utilization varied between 60% and 85%, with Southern Europe showing higher utilization despite moderate acquisition levels. Higher GHE was positively associated with hearing aid acquisition (R² = 0.27, P = 0.021); while OOP were negatively associated with acquisition (R² = 0.33, P = 0.002). Waiting times were marginally associated with utilization. Notably, the composite index demonstrated stronger associations with both acquisition (R²= 0.50, P < 0.001) and utilization (R² = 0.20, P = 0.012) than individual macro-level factors alone, highlighting the synergistic effects of macro-level determinants.
CONCLUSIONS: Macro-level determinants, including GHE, OOP and waiting times were associated with hearing aid acquisition, but showed weaker or no significant associations with utilization. Addressing financial and systemic barriers through targeted policy interventions is critical to improving hearing healthcare access and mitigating the burden of untreated hearing loss. Future research should explore the interplay between macro- and individual-level factors to inform development of effective interventions.
METHODS: Data about 28 countries that participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) were sourced from SHARE Wave 9 (2024), EFHOH 2022 report, and OECD Health Statistics Library. Linear regression models assessed the associations between country-level hearing aid acquisition and utilization rates and macro-level predictors including referral route, government health expenditure (GHE), out-of-pocket (OOP) payments, and waiting times. A composite index integrating these explanatory factors was constructed to assess their combined influence. Additionally, logistic regression models analyzed individual-level associations with hearing aid acquisition and utilization.
RESULTS: Hearing aid acquisition rates ranged from 5% to 45%, with Northern Europe exhibiting the highest rates and Eastern Europe the lowest. Among hearing aid owners, utilization varied between 60% and 85%, with Southern Europe showing higher utilization despite moderate acquisition levels. Higher GHE was positively associated with hearing aid acquisition (R² = 0.27, P = 0.021); while OOP were negatively associated with acquisition (R² = 0.33, P = 0.002). Waiting times were marginally associated with utilization. Notably, the composite index demonstrated stronger associations with both acquisition (R²= 0.50, P < 0.001) and utilization (R² = 0.20, P = 0.012) than individual macro-level factors alone, highlighting the synergistic effects of macro-level determinants.
CONCLUSIONS: Macro-level determinants, including GHE, OOP and waiting times were associated with hearing aid acquisition, but showed weaker or no significant associations with utilization. Addressing financial and systemic barriers through targeted policy interventions is critical to improving hearing healthcare access and mitigating the burden of untreated hearing loss. Future research should explore the interplay between macro- and individual-level factors to inform development of effective interventions.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE352
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)