UNSAF

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UNSAF

• Personal, social and economic consequences of
  hearing loss
• Kim Ruberg
• Secretary General
• Hear-It AISBL

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Aims of project

• To carry out wide review of literature on effects
  of hearing impairment including
• prevalence of hearing impairment in Europe
• psychosocial effects of hearing impairment
• use of hearing aids
• costs of hearing impairment

• To estimate current costs to Europe of untreated
  hearing impairment

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Scope of project

• Hearing impaired adults only
• Hearing impairment that would benefit from
  hearing aids
• eg not tinnitus
• Definitions of Europe
• European Union (25 member states)
• Continent of Europe (not Russia, Turkey, includes
  Ukraine)

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The Bridget Shield report at a glance

• Hearing loss is much more prevalent and damaging
  to individuals and society and the benefits from
  proper treatment are much greater than previously
  believed.
• The cost to society of untreated hearing loss is
  a staggering 215 billion euro a year for all of
  Europe and 170 billion euro a year for the
  countries of the European Union.
• The most comprehensive scientific empirical
  study ever performed of the consequences of
  hearing loss.

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Prevalence of HL in Europe

• Data from studies of the prevalence of HL in
  several European countries have been reanalysed
  to estimate the current prevalence of different
  grades of HL in Europe

May be underestimates owing to upper age limits
of 75 and 80 in studies considered
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Psychosocial effects of hearing loss

• Hearing loss causes
• loneliness/social isolation
• psychiatric disturbance/depression
• low self esteem
• employment difficulties
• memory loss
• prejudice/abuse

• Hearing loss affects
• overall quality of life
• family relationships
• education
• general health
• visiting doctor
• social life
• going to restaurants, theatres, church etc

Hearing loss reduces overall quality of life
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Impact of hearing aids on quality of life
Results of many studies over past 25 years

• Greater self confidence and higher self-esteem
• Reduced deterioration in psychological
  functioning
• Reduction in physical health difficulties
• Psychosocial improvements
• Greater satisfaction with life and less
  depression
• Benefits in social life, group activities,family
  relationships
• Satisfaction higher with greater hearing
  loss/does not depend on age
• Better emotional life
• Better cognitive functioning
• Greater overall health status

Improvements occur in first few weeks after
fitting
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Evaluation of costs of hearing loss

• Method
• Review of previous studies
• Selection of method
• Determination of values of required data
• Calculations

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Cost effectiveness of cochlear implants

• Uses cost utility analysis
• method of evaluating cost effectiveness of
  medical interventions
• Based upon health utility index and quality
  adjusted life year (QALY)
• Health utility index number between 0 and 1
• 1 corresponds to full health, 0 to death
• Average value of HUI for adult in Europe is 0.85
  (Sorri et al, 2001)

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Cost effectiveness of cochlear implants
Meta analysis of nine previous studies (Cheng
and Niparko, 1999)

• All studies assigned health utility values to
  profoundly deaf adults with and without cochlear
  implants
• Results of all studies very consistent

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Evaluation of hearing loss in Europe
Quality of life approach

• Data required
• Numbers of hearing impaired people in Europe
• Numbers of people who would benefit from hearing
  aids but do not have them
• Quality of life value for each degree of hearing
  loss
• Monetary value associated with full quality of
  life year

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Prevalence of HL in Europe

• Assumed prevalence in Europe

Population of Europe (millions)
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Prevalence of HL in Europe

• Estimates of numbers of HI adults in Europe who
  would benefit from hearing aids (ie BEHL gt 25
  dB) (millions)

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Evaluation using QoL approach

• Need to assign HUI to degrees of HL

Following values have been assumed
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Evaluation using QoL approach

• Need to assign value to full quality life year

European Commission value (2003) 44,000 euros

• Annual cost of hearing impairment per person

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Evaluation using QoL approach

• Total costs
• (Millions of euros)

Overall costs (billions of euros)
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Evaluation using QoL approach

• Costs of unaided hearing impairment
• (billions of euros)

Assuming 1 in 4 hearing impaired people use aid
NB - underestimate as even if 1 in 4 own an aid,
fewer will use one
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Conclusion
Using this method

• Cost to European Union of hearing loss is between
  170 and 226 billion euros annually
• Cost to whole of Europe of hearing loss is
  between 215 and 286 billion euros annually

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Untreated Hearing Loss Costs France 19-25
Billion Euro per Year

• Untreated hearing loss costs France 19-25 billion
  euros per year, according to a new, previously
  undisclosed multinational scientific report,
  Evaluation of the Social and Economic Costs of
  Hearing Impairment. This equals 350-400 euros
  per year for each person in France.
• 16 of all adult French, more than 7,5 million
  people, suffer from a hearing loss of more than
  25 dB, the definition of hearing loss recognised
  by the World Health Organisation, WHO. People
  with a hearing loss of more than 25 dB generally
  have daily problems caused by their hearing loss.
  Yet, fewer than one in six of those who could
  benefit from using hearing aids are being treated
  adequately

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New international scientific report showsMore
than 7.5 Million Hearing Impaired in France

• Just a small minority of those in need use
  hearing aids even though hearing aids can ensure
  employment and improve quality of life.
• 16 of all adult French citizens, more than 7.5
  million people, suffer from a hearing loss of
  more than 25 dB, the definition of hearing
  impairment recognised by the World Health
  Organisation, WHO. People with a hearing loss of
  more than 25 dB generally have daily problems
  caused by their hearing loss. At work
  conversations with colleagues, and the
  concentration needed for communication during the
  day demand much energy, potentially affecting
  both mood and work efficiency. Untreated hearing
  loss may also affect your social and family life,
  lower your quality of life and cause mental
  anguish.

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What to do about it

• We try to document and persuade
• Document that life quality is reduced
  drastically if you have a hearing loss
• Document that treating your hearing loss
  drastically increases your quality of life
• Document that a hearing loss decreases your
  productivity and your income
• Document that this loss in productivity and
  income is reduced by treating your hearing loss.
• Document that proper intervention against
  hearing loss is one of the best investments for
  any society.

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UNSAF
Thank you for listening

• Personal, social and economic consequences of
  hearing loss
• Kim Ruberg
• Secretary General
• Hear-It AISBL

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Help us (and yourself) State the facts loudly

• - The costs of untreated hearing are so high
  economically to society and in terms of personal
  consequences for so many individuals that we must
  take this problem seriously, on the individual
  level and as a society.
• - With 16 of all adults suffering from hearing
  loss, we all have to be more aware of the problem
  and talk about it without prejudices. In
  particular, I find it extremely important that
  family doctors generally must be more focused on
  potential hearing loss in individual patients.
• - Typically, the closest family members are most
  deeply affected when a person has a hearing loss.
  Conversations become shorter, less frequent, less
  spontaneous and less personal. They sense a loss
  of intimacy, withdrawal and changed personality.

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Help us (and yourself) State the facts loudly

• - As a family member of a hearing impaired
  individual you can do a lot to help. Most often
  relatives are the ones to first discover when
  someone may have a hearing loss. Family members
  must be supportive, understanding and helpful and
  approach the situation in a gentle way. The
  hearing impaired individual may be unaware of the
  problem and sensitive to the idea of having a
  hearing loss.
• - Family members are those most affected by
  someones hearing loss, with the exception of the
  hearing impaired person. Conversely, family
  members enjoy the greatest benefits when the
  hearing loss is treated.
• - Hearing tests should be a natural and
  integrated part of getting a health check at the
  family doctor for anyone aged 40 years or older.

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Help us (and yourself) State the facts loudly

• - About half of all hearing impaired people are
  of working age or younger. The major reason for
  this is that hearing impairment occurs earlier
  and earlier in life, most likely because of our
  increased exposure to loud music noise.
• - We all loose our hearing sooner or later.
  Hearing loss is a natural consequence of getting
  older. But more and more loose their hearing
  early in life because of exposure to loud music
  or other excessive noise.
• - Todays digital hearing aids are placed either
  inside or discreetly behind the ear. Digital
  hearing aids make all the difference in the
  quality of life for many hearing impaired people.
• - Hearing aids take time getting used to, like
  bifocal glasses. The longer you use your hearing
  aids the better youll like them.

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BSHAA
Thank you for listening

• Personal, social and economic consequences of
  hearing loss
• Kim Ruberg
• Secretary General
• Hear-It AISBL

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BSHAA
Consult Utilize Support www.hear-it.org

• Kim Ruberg
• Secretary General
• Hear-It AISBL

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Evaluation of costs of hearing loss

• Review
• Very few relevant previous studies
• None directly applicable
• Many studies on cost effectiveness of cochlear
  implants

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Previous studies
Societal costs of moderate hearing
impairment The Maastricht study (Joore et al,
2003)

• Netherlands
• 80 subjects, 10 in paid employment
• Considered factors which have economic impact
• health related quality of life
• social functioning
• productivity in paid and unpaid labour
• use of medical services
• Concluded hearing aids are highly cost effective
• Quality of life increases significantly with
  hearing aids

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Previous studies
The costs of communication disorders (USA, Ruben,
2001)

• Considered losses to economy of unemployment and
  underemployment of people with communication
  disorders
• hearing
• voice
• speech and language
• Results translated into monetary values
• Annual costs to US economy 154 to 186 billion

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Previous studies
Societal costs of severe to profound hearing
loss (USA, Mohr et al, 2003)

• Very comprehensive study
• Calculate lifetime costs of an individual
• medical costs associated with hearing loss
• special education and rehabilitation
• productivity costs (reduced earnings over
  lifetime)
• Largest component is reduced productivity
• Average cost to society over lifetime of
  individual is 297,000
• But no account taken of psychosocial effects

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Previous studies
Societal costs of severe to profound hearing
loss (Mohr et al, 2003)
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Previous studies
Societal costs of severe to profound hearing
loss (Mohr et al, 2003)
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Previous studies
Costs to UK of new EC Noise at Work Regulations
(Health and Safety Executive, 2003) (UK
Government body responsible for health and safety
at work, in transport etc)

• Used quality of life approach in evaluating
  NIHL
• Quantified reduction in quality of life (QoL)
  associated with degree of hearing loss
• Converted reduction in QoL to monetary value
  assuming one full quality life year has value of
  42,000 (standard UK value)
• Calculated value of hearing loss over remaining
  working life

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Challenge to old beliefs

• Many more people than previously believed are
  hearing impaired.
• Hearing impairment generally affects people at a
  younger age than previously assumed.
• Hearing loss reduces the quality of life much
  more than previously assumed.
• Hearing loss has a much stronger negative impact
  on family life than previously assumed.
• Hearing loss makes many more people than
  previously assumed retire early from the
  workforce.
• Hearing loss costs society much more than
  previously assumed.

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Challenge to old beliefs

• Proper intervention against hearing loss benefits
  hearing impaired people much more than previously
  believed.
• Proper intervention against hearing loss benefits
  families of hearing impaired people much more
  than previously assumed.
• Proper intervention against hearing loss keeps
  hearing impaired people on the workforce much
  longer than previously assumed.
• Proper intervention against hearing loss benefits
  society much more than previously assumed,
  economically as well as socially

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Satisfaction with life
Table 5.2 Percentages of adults aged 51 to 61
dissatisfied with various aspects of life
With hearing loss Without hearing loss
Life as a whole 9 4
Health/physical condition 28 12
Financial situation 37 22
Friendships 6 3
Family life 7 3
Handling of problems 9 4
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Difference hearing impaired or not
Table 3.1 Significant differences between
hearing impaired and control groups (Thomas and
Herbst, 1980)
Category of effect Hearing impaired Control group
Psychiatric disturbance 19 57 5
Health problems 28 13
Loneliness 24 14
Social isolation 40 25
Difficulty making friends 40 15
Lack of emotional support 45 26
Left out of family life 27 12
Figure for the general population, not the
control group Refers to those with gt70 dB HL
and speech discrimination lt 70
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Labour market
Table 5.1 Comparison of labour participation rate
in severe to profoundly hearing impaired and
non-hearing impaired 11
Age Severe to profoundly hearing impaired Severe to profoundly hearing impaired Non-hearing impaired Non-hearing impaired
Age Number Percentage Number Percentage
18-44 149 59 97737 77
45-64 273 49 45299 68
65 and over 851 7 28443 13
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Retirement
Table 5.3 Percentages of adults aged 51 to 61
concerned with various aspects of retirement
With hearing loss Without hearing loss
Completely retired 18 12
Poor health a factor in deciding to retire 70 44
Wanted to retire 23 42
Satisfaction with retirement 29 42
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Users non users
Table 5.4 Percentages of respondents involved in
social activities or experiencing negative
emotions 15
Milder loss Milder loss More severe loss More severe loss
Users Non-users Users Non-users
Sad or depressed 14 23 22 30
Worried or anxious 7 12 12 17
Participation in social activities 47 37 42 32
Participation in senior centre activities 24 15 21 16
Paranoia 13 24 14 36
Insecure 8 10 11 17
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Effects of HL and use of HA
Table 5.4 Percentages of respondents involved in
social activities or experiencing negative
emotions 15
Milder loss Milder loss More severe loss More severe loss
Users Non-users Users Non-users
Sad or depressed 14 23 22 30
Worried or anxious 7 12 12 17
Participation in social activities 47 37 42 32
Participation in senior centre activities 24 15 21 16
Paranoia 13 24 14 36
Insecure 8 10 11 17
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Table 6.2. Percentages of users and family
members reporting improvements from using hearing
aids
Percentages reporting improvement Percentages reporting improvement Percentages reporting improvement Percentages reporting improvement Percentages reporting improvement Percentages reporting improvement
All All Milder loss Milder loss More severe loss More severe loss
Users Family Users Family Users Family
Relationships at home 56 66 44 59 60 68
Feelings about self 50 60 40 54 53 61
Life overall 48 62 33 53 53 64
Mental health 36 39 29 37 38 35
Self-confidence 39 46 28 35 42 48
Relations with children and grandchildren 40 52 28 44 43 53
Willing to participate in group activities 34 44 23 33 37 47
Sense of independence 34 39 27 30 36 41
Sense of safety 34 37 25 32 37 38
Ability to play card/board games 31 47 25 39 33 49
Social life 34 41 27 28 36 45
Physical health 21 24 21 21 21 25
Dependence on others 22 31 17 26 24 32
Relations at work 26 43 19 37 28 45
Ability to play sports 7 10 8 11 7 9
Sex life 8 N/A 4 N/A 9 N/A
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Previous studies
Costs to UK of new EC Noise at Work Regulations
(Health and Safety Executive, 2003)
Value of hearing loss based upon value of
42,000 for full quality life year
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Previous studies
Costs to UK of new EC Noise at Work Regulations
(Health and Safety Executive, 2003)
Value of hearing loss over remaining working life
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Definitions of grades of deafness

• Note differences between organisations
• normal hearing BEHL of up to 20 dB or up to
  26 dB
• Differences of up to 14 dB HL in definition of
  severe/profound HL
• In evaluating costs, only those with BEHL gt 25
  dB considered

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Evaluation of costs of hearing loss

• Different approaches
• Direct calculation of costs
• Quality of Life approach
• uses health utility index
• standard method used for evaluating cost
  effectiveness of various medical interventions
• Combination of above methods

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Prevalence of HL in Europe

• Estimates of numbers of hearing impaired adults
  in Europe (millions)

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Evaluation of costs of hearing loss

• Health utility index
• Health utility index number between 0 and 1
• 1 corresponds to full health
• 0 corresponds to death
• subjective evaluation of quality of life
• A quality adjusted life year (QALY) is the
  value of a year of full health adjusted by the
  health utility index

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Why people dont say YES
TABLE 6.1. PERCENTAGES OF NON-USERS OF HEARING
AIDS CITING VARIOUS REASONS FOR NON-USE 1
Type of reason All Type of loss Type of loss
Type of reason All More severe Milder
Denial Hearing not bad enough 69 64 73
Denial Can manage without 68 55 78
Consumer concerns Too expensive 55 64 48
Consumer concerns Wont help my problem 33 36 31
Consumer concerns They dont work well 28 31 26
Consumer concerns Mistrust hearing specialists 25 29 22
Consumer concerns Tried, didnt work 17 20 15
Stigma/ vanity Make me feel old 20 22 18
Stigma/ vanity Dont like way they look 19 21 18
Stigma/ vanity Embarrassment 18 21 16
Stigma/ vanity Dont like what others think 16 19 15
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Ownership of hearing aids

• Percentages of population wearing hearing aids in
  Northern Europe (Sorri et al, 2001)

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Ownership of hearing aids

• Percentages of population wearing hearing aids in
  Northern Europe (Sorri, 2001)

In Europe only about 1 in 4 of people who could
benefit from using a hearing aid have one
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- and then what

• Hear-It makes our data available to ALL
  interested parties sharing our objectives
• Hear-It assists in building national or regional
  campaigns
• - lets look at some possibilities

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3 reasons why people dont say YES
STIGMA
Hearing not bad enough
STIGMA

• Too expensive/wont help

STIGMA

• Make me feel/look old

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Evaluation of the social and economic costs of
hearing loss in Europe
Bridget Shield Professor of Acoustics London
South Bank University