Hearing health geography in England: findings from the English longitudinal study of ageing (ELSA) and evidence of a north-south divide

Objective:To explore regional patterns and trends of hearing loss (HL) in a representative longitudinal prospective cohort study of the English population aged 50 years and above.Method:We used the full dataset (74,699 person-years) of the English Longitudinal Study of Ageing (ELSA). We examined the geographical identifiers of the participants at Geographical Office Regions (GOR) level, and the geographically based Index of Multiple Deprivation (IMD). We computed Adjusted Predictions at the Means (APMs) and the Marginal Effects at the Means (MEMs) of the HL prevalence in each ELSA Wave, with age, gender, education, occupation, income, wealth, IMD and alcohol consumption as the factor variables.Results:Between 2002-2017 there was an estimated increase of 10.2% in the total HL prevalence in the English older population: 38.50 (95%CI 37.37-39.14) in Wave 1, to 48.66 (95%CI 47.11-49.54) in Wave 8. The Hot Spot and Cold Spot analyses showed marked regional variability and evidence of a North-South divide. There was a wide variation in HL prevalence in representative samples from different regions in England that had similar age profiles, and the increase rate of HL ranged from 3.2% to 45%.Implications:These results provided evidence that the increasing trend in HL prevalence is not related to the ageing of the population, as widely believed, as the samples had significantly equal age but differed markedly on their HL outcomes, both regionally and chronically. A socio-spatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities