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Individual-level and area-level socioeconomic inequalities in hearing impairment among Chinese adults: a population-based study
  1. Yanan Luo1,2,3,
  2. Jiamin Gao4,5,
  3. Xiaoying Zheng1,2
  1. 1Institute of Population Research, Peking University, Beijing, China
  2. 2APEC Health Science Academy, Peking University, Beijing, China
  3. 3Advanced Systems Analysis, International Institute for Applied Systems Analysis, Laxenburg, Austria
  4. 4Guanghua School of Management, Peking University, Beijing, China
  5. 5Institute of Strategic Research, Peking University, Beijing, China
  1. Correspondence to Professor Xiaoying Zheng, Peking University Institute of Population Research, Beijing 100871, China; xzheng{at}


Background It is unclear whether individual-level and area-level socioeconomic status (SES) is associated with hearing impairment (HI). This study determines an association of individual SES, area SES and their interaction with HI among working-aged adults.

Methods Data were obtained from the large, population-based sample of the Second China National Sample Survey on Disability, a cross-sectional study conducted in China. A total of 1 333 528 participants aged 25–59 years were included. HI was measured by pure-tone audiometry (PTA) and audiologists further ascertained for a final diagnosis. Individual SES was defined as a summed of z-scored of education level and household income per capita, and area SES was calculated as a summed of z-scored of county-level income per capita, high school rate, poverty rate and rate of upper-class occupation. Multilevel logistic regression was used.

Results Individual and area SES were associated with HI among Chinese working-aged adults. A 1-SD increase in individual SES was associated with decreased risk of HI (OR=0.3, 95% CI: 0.3 to 0.3). Area SES was positively related to HI (OR=1.2, 95%CI: 1.2 to 1.3). The cross-level interaction on individual and area SES was significantly associated with HI, indicating that among those who lived in higher SES areas, participants with lower SES had a greater likelihood to develop HI.

Conclusions Significant individual and area socioeconomic inequalities were observed in HI among Chinese working-aged adults. Lower SES adults who resided in prosperous areas may face more deprivation on hearing health than those with higher SES.

  • ageing
  • disability
  • health promotion

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  • Contributors YL and JG: contributed equally to this study. YL: helped to conceptualise the study, analysed the data and participated in writing the article. JG: initiated the idea, conceptualised the study and wrote the original article. XZ: supervised all aspects of its implementation and contributed to writing the article. All authors gave final approval of the version to be published.

  • Funding This work was supported in part by the Australian National Health and Medical Research Council (NHMRC) (Project Grant ID 1028822 and 1024516; Centre of Clinical Research Excellence Grant ID 546519; Centre of Research Excellence Grant ID 1060733; Senior Research Fellowship ID 1081288 to P.J.A.; Early Career Fellowship ID 1053787 to J.L.Y.C., ID 1053767 to A.J.S., ID 1012236 to D.K.T.; Career Development Fellowship ID 1141354 to J.L.Y.C., ID 1108714 to A.J.S., ID 1085754 to D.K.T.), Murdoch Children’s Research Institute Clinical Sciences Theme Grant, the Royal Children’s Hospital, the Department of Paediatrics at the University of Melbourne, the Victorian Government Operational Infrastructure Support Program, and The Royal Children’s Hospital Foundation.

  • Disclaimer The study sponsors had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the manuscript for publication.

  • Competing interests CK wrote the first draft of the manuscript and no honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data obtained from a third party and are not publicly available.