unsaf personal, social and economic consequences of hearing loss kim ruberg secretary general...

UNSAF

Personal, social and economic consequences

of hearing loss

Kim RubergSecretary GeneralHear-It AISBL

Aims of project

To estimate current costs to Europe of untreated hearing impairment

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

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)

Scope of project

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.

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

Mild Moderate Severe ProfoundBEHL 21-39 40-69 70-94 >94% pop 16.9 4.6 0.7 0.2

May be underestimates owing to upper age limits of

75 and 80 in studies considered

Psychosocial effects of hearing loss

Hearing loss causesloneliness/social isolationpsychiatric disturbance/depressionlow self esteememployment difficultiesmemory lossprejudice/abuse

Hearing loss affectsoverall quality of lifefamily relationshipseducationgeneral healthvisiting doctorsocial life

going to restaurants, theatres, church etc

Hearing loss reduces overall quality of life

0

10

20

30

40

50

60

%

Psychiatricdisturbance

Health problems Loneliness Social isolation Difficulty makingfriends

Lack ofemotionalsupport

Left out of familylife

Difference hearing impaired or not

Hearing Impaired Control Group

Significant differences between hearing impaired and control groups (Thomas and Herbst, 1980)

With > 70dB HI

0

5

10

15

20

25

30

35

40

%

Life as a whole Health/physicalcondition

Financial situation Friendships Family life Handling of problems

Satisfaction with life

With hearing loss Without hearing loss

0

10

20

30

40

50

60

70

%

Completely retired Poor health a factor in deciding toretire

Wanted to retire Satisfaction with retirement

Retirement


Table 5.3 Percentages of adults aged 51 to 61 concerned w ith

various aspects of retirement

0

10

20

30

40

50

60

70

80

%

18-44 45-64 65 and over

Labour Market

Severe to profound HL Non-hearing impaired

Table 5.1 Comparison of labour participationrate in severe to profoundly hearing impaired and non-hearing impaired [11]

Impact of hearing aids on quality of life

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

Results of many studies over past 25 years

Improvements occur in first few weeks after fitting

0

5

10

15

20

25

30

35

40

45

50

%

Sad ordepressed

Worried oranxious

Participationin socialactivities

Participationin senior

centreactivities

Paranoia Insecure

Milder Loss

Users Non-users

0

5

10

15

20

25

30

35

40

45

%

Sad ordepressed

Worried oranxious

Participationin socialactivities

Participationin senior

centreactivities

Paranoia Insecure

More Severe Loss

Users Non-users

0

10

20

30

40

50

60

%

Relationships at home

Feelings about self

Life overall

Self-confidence

Relations with children and grandchildren

Willing to participate in group activities

Ability to play card/board games

Social life

Dependence on others

Relations at work

Improvement from HA - Milder

Users Family

0

10

20

30

40

50

60

70

%


Feelings about self

Life overall

Self-confidence




Social life


Relations at work

Improvement from HA - More Severe Loss

Users Family

Evaluation of costs of hearing loss

Method

Review of previous studiesSelection of methodDetermination of values of required dataCalculations

Cost effectiveness of cochlear implants

Uses ‘cost utility analysis’method of evaluating cost effectiveness of medical

interventionsBased 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 deathAverage value of HUI for adult in Europe is 0.85

(Sorri et al, 2001)

Cost effectiveness of cochlear implants

All studies assigned health utility values to profoundly deaf adults with and without cochlear implants

Results of all studies very consistent

Meta analysis of nine previous studies (Cheng and Niparko, 1999)

Mean HUIProfound deafness (no CI) 0.54With cochlear implant 0.8

Evaluation of hearing loss in Europe

Quality of life approach

Data required

Numbers of hearing impaired people in EuropeNumbers of people who would benefit from hearing aids but do not have themQuality of life value for each degree of hearing lossMonetary value associated with full quality of life year


Assumed prevalence in Europe

Mild Moderate Severe ProfoundBEHL 21-39 40-69 70-94 >94% pop 16.9 4.6 0.7 0.2

Total AdultEuropean Union 457 355Rest of Europe 122 95Whole of Europe 579 450

Population of Europe (millions)


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

Mild Moderate Severe ProfoundEuropean Union 37 16.3 2.5 0.7Rest of Europe 10 4.4 0.7 0.2Whole of Europe 47 20.7 3.2 0.9

Evaluation using QoL approach

Need to assign HUI to degrees of HL

Profound deafness (no CI) 0.54With cochlear implant 0.8Average adult 0.85

Following values have been assumed:

Mild Moderate Severe ProfoundHealth Utility Index 0.8 0.7 0.6 0.55

Mild Moderate Severe ProfoundLoss in HUI due to HL 0.05 0.15 0.25 0.3


Need to assign value to full quality life year

Mild Moderate Severe ProfoundLoss in HUI due to HL 0.05 0.15 0.25 0.3Cost in euros 2,200 6,600 11,000 13,200

European Commission value (2003)

44,000 euros

•Annual cost of hearing impairment per person:


Total costs(Millions of euros)

Mild Moderate Severe ProfoundEuropean Union 81,000 108,000 27,000 9,000Rest of Europe 22,000 29,000 7,000 3,000Whole of Europe 103,000 137,000 35,000 12,000

Overall costs (billions of euros)European Union 226Rest of Europe 60Whole of Europe 286


Costs of unaided hearing impairment(billions of euros)

Assuming 1 in 4 hearing impaired people use aid

European Union 170Rest of Europe 45Whole of Europe 215

NB - underestimate as even if 1 in 4 own an aid, fewer will use one

Conclusion

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

Using this method

0

50

100

150

200

250

300

350

400

Euro

Obesity

Hepatitis B

Diabetes

Alcohol

Schizophrenia

Asthma

Asthma

Mental disorders

Migraine

Coronary heart disease

Smoking

Smoking

Obesity

Hearing loss

Hearing loss

Annual cost € pr. person Australia2006 Hear-It

2006

0

100.000

200.000

300.000

400.000

500.000

600.000

1998US $

Accidents with fireams

Near drowning

Strokes

Rheumatoid arthritis (25 yrs)

Epilepsy (frequent seizures)

Schizophrenia

Severe to profound hearing loss

Family with member with MS

Societal costs of severe to profound hearing loss

Source: Mohr et. Al., 2003

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

New international scientific report shows:

More 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.

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.

UNSAF


of hearing loss


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.


- 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 someone’s 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.


- 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.

- Today’s 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 you’ll like them.

BSHAA


of hearing loss


BSHAA



Review

Very few relevant previous studiesNone directly applicableMany studies on cost effectiveness of

cochlear implants

Previous studies

Netherlands 80 subjects, 10 in paid employment Considered factors which have economic impact

health related quality of lifesocial functioningproductivity in paid and unpaid labouruse of medical services

Concluded hearing aids are highly cost effectiveQuality of life increases significantly with hearing aids

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

Previous studies

Considered losses to economy of unemployment and underemployment of people with communication disorders hearingvoicespeech and language

Results translated into monetary values Annual costs to US economy: $154 to $186 billion

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

Previous studies

Very comprehensive study Calculate lifetime costs of an individual

medical costs associated with hearing lossspecial education and rehabilitationproductivity 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

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

Previous studiesSocietal costs of severe to

profound hearing loss(Mohr et al, 2003)

Condition 1998 US$Accidents with fireams 89,100Near drowning 98,500Strokes 129,200Rheumatoid arthritis (25 yrs) 130,500Epilepsy (frequent seizures) 172,900Schizophrenia 295,000Severe to profound hearing loss 297,000Family with member with MS 593,000

Previous studies

Societal costs of severe to profound hearing loss

(Mohr et al, 2003)Condition 1998 US$

Accidents with fireams 89,100Near drowning 98,500Strokes 129,200Rheumatoid arthritis (25 yrs) 130,500Epilepsy (frequent seizures) 172,900Schizophrenia 295,000Severe to profound hearing loss 297,000Family with member with MS 593,000

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

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.

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

Satisfaction with life

Table 5.2 Percentages of adults aged 51 to 61 dissatisfied with various aspects of life


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

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 1957*

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 >70 dB HL and speech

discrimination < 70%

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

Non-hearing impaired

Number Percentage Number Percentage

18-44 149 59 97737 77

45-64 273 49 45299 68

65 and over 851 7 28443 13

Retirement

Table 5.3 Percentages of adults aged 51 to 61 concerned with various aspects of retirement


Completely retired 18 12

Poor health a factor in deciding to retire

70 44

Wanted to retire 23 42

Satisfaction with retirement 29 42

Users – non users

Table 5.4 Percentages of respondents involved in social activities or experiencing negative emotions [15]

Milder 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

Effects of HL and use of HATable 5.4 Percentages of respondents involved in social activities or experiencing negative emotions [15]

Milder 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

Table 6.2. Percentages of users and family members reporting improvements from using hearing aids

Percentages reporting improvement

All Milder 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


40 52 28 44 43 53


34 44 23 33 37 47

Sense of independence 34 39 27 30 36 41

Sense of safety 34 37 25 32 37 38


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

Previous studies

Costs to UK of new EC Noise at Work Regulations (Health and Safety Executive, 2003)

Hearing loss (dB) Reduction in QoL Value (£)50 10% 4,20030 5% 2,100

20 to 30 2.50% 1,05015 to 20 1% 42010 to 15 0.25% 105

<10 0% 0

Value of hearing loss based upon value of

£42,000 for full quality life year

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

Hearing loss (dB) Value (£)50 96,00030 48,000

20 to 30 24,00015 to 20 9,60010 to 15 2,400

<10 0

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 >= 25 dB considered

None Mild Moderate Mod-sev Severe ProfoundWHO < = 25 26 - 40 41 - 60 61 - 80 Above 80EC < = 20 21 - 39 40 - 69 70 - 94 95 & aboveANSI < = 26 27 - 40 41 - 55 56 - 70 71 - 90 Above 90RNID 25 - 39 40 - 69 70 - 94 95 & aboveBSA 20 - 40 41 - 70 71 - 95 Above 95

0

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%

Sad or depressed Worried or anxious Participation in socialactivities

Participation in seniorcentre activities

Paranoia Insecure

Users - non users Milder Loss

Users Non-users

Table 5.4 Percentages of respondents involved in

social activities or experiencing negative emotions [15]

Users - non-users More Severe Loss

0

5

10

15

20

25

30

35

40

45

Sad or depressed Worried or anxious Participation in socialactivities

Participation in seniorcentre activities

Paranoia Insecure

%

Users Non-usersTable 5.4 Percentages of respondents involved in

social activities or experiencing negative emotions [15]


Different approaches

Direct calculation of costs ‘Quality of Life’ approach

uses ‘health utility index’standard method used for evaluating cost effectiveness

of various medical interventionsCombination of above methods


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

Mild Moderate Severe ProfoundEuropean Union 60 16.3 2.5 0.7Rest of Europe 16 4.4 0.7 0.2Whole of Europe 76 20.7 3.2 0.9


Health utility indexHealth utility index: number between 0 and 1

1 corresponds to full health0 corresponds to deathsubjective 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

Why people don’t 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

More severe Milder

DenialHearing not bad enough 69 64 73

Can manage without 68 55 78

Consumer concerns

Too expensive 55 64 48

Won’t help my problem 33 36 31

They don’t work well 28 31 26

Mistrust hearing specialists 25 29 22

Tried, didn’t work 17 20 15

Stigma/vanity

Make me feel old 20 22 18

Don’t like way they look 19 21 18

Embarrassment 18 21 16

Don’t like what others think 16 19 15

Ownership of hearing aids

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

Denmark 3.4Finland 1Norway 2.4Sweden 2.3UK 3.5

Ownership of hearing aids

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

Denmark 3.4Finland 1Norway 2.4Sweden 2.3UK 3.5Average 2.5

In Europe only about 1 in 4 of people who could

benefit from using a hearing aid have one

0

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20

30

40

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60

70

%


Feelings about self

Life overall

Self-confidence




Social life


Relations at work

Improvement from HA - All

Users Family

- 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

- let’s look at some possibilities

3 reasons why people don’t say YES

Hearing not bad enough

Too expensive/won’t help

Make me feel/look old

Evaluation of the social and economic costs of hearing

loss in Europe

Bridget ShieldProfessor of Acoustics

London South Bank University

unsaf personal, social and economic consequences of hearing loss kim ruberg secretary general...

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