1. Hearing impairment among 50+ year old Europeans Results from the SHARE survey Karen Andersen-Ranberg, MD, PhD Associate Professor, Andreas Kryger Jensen, MSc Danish Ageing Research Centre University of Southern Denmark

2. What is SHARE? The Survey of Health, Ageing and Retirement in Europe

3. Why SHARE? Population ageing and its social and economic challenges to growth and prosperity are among the most pressing challenges of the 21 st century in Europe, The European Commission, the Council and the European Parliament have repeatedly emphasized this. SHARE aims at delivering scientific support by collecting micro data on health, economic and social living conditions of individuals -as they age -as they are exposed to the societal changes

4. * * * Israel SE DK IR DE CHAT FR ES IT GR BE NL PL CZ UK USA Korea Japan * PT * SL * * * * ES HU SHARE countries wave 1 New SHARE countries wave 2 * New SHARE countries wave 4 * Comparability with:

5. Who participates in SHARE? Wave 1 (2004): Sweden, Denmark, the Netherlands, Belgium, Germany, Austria, Switzerland, France, Spain, Italy, Greece, (Israel) Wave 2 (2006): Wave 1 countries + Poland, Czech Republic, (Ireland) Wave 3 (2008) = SHARELIFE (retrospective survey): Wave 1 countries + Poland, Czech Republic Wave 4 (2010 – launch in november 2010): Wave 1 + wave 2 countries + Estonia, Luxembourg, Portugal, Slovenia, Hungary

6. Why is SHARE longitudinal? 2022 2020 2018 2016 2014 2012 2010 2008 2006 2004 5052545658606264666870727476788082848688 AGE Calendar year Follow people while they age Help us disentangle period and cohort effects

7. Why refreshers (new participants)? 2022 2020 2018 2016 2014 2012 2010 2008 2006 2004 5052545658606264666870727476788082848688 AGE Calendar year Compare age groups Help us understand cohort differences

8. Comparison across the same age (cohort differences) 2022 2020 2018 2016 2014 2012 2010 2008 2006 2004 5052545658606264666870727476788082848688 AGE Calendar year Compare age groups Help us understand cohort differences

9. Why is SHARE cross-disciplinary? Morbidity, Disability, Mortality Children, social network, living conditions dynamic  longitudinel Income, security, wealth Political decisions

10. What do we ask SHARE participants? Self-reported Health: health conditions, physical and cognitive functioning, health behaviour, health care use Screening tests: Cognitive and depression Physical tests: grip strength, walking speed, BMI, expiratory peak flow, Psychological variables: psychological health, well-being, life satisfaction Economic variables: current work activity, job characteristics, opportunities to work past retirement age, sources and composition of current income, wealth and consumption, Housing, Education Social support variables: assistance within families transfers of income and assets social networks, volunteer activities

11. What do we ask SHARE participants? Health variables: e.g. self-reported health, health conditions, physical and cognitive functioning, health behaviour, use of health care facilities Screening tests: cognitive testing, depressive symptoms Physical tests (bio-markers): e.g. grip strength, body-mass index, expiratory peak flow, walking speed Psychological variables: e.g. psychological health, well-being, life satisfaction Economic variables: current work activity, job characteristics, opportunities to work past retirement age, sources and composition of current income, wealth and consumption, housing, education Social support variables: e.g. assistance within families, transfers of income and assets, social networks, volunteer activities

12. Which variables have been used for this presentation? Are you usually wearing a hearing aid? Answer: Yes/No Is your hearing [using a hearing aid as usual]… Answer: Excellent/very good/good/fair/poor Do you find it difficult to follow a conversation if there is background noise, such as a TV, a radio or children playing [using a hearing aid as usual]? Answer: Yes/No Can you hear clearly what is said in a conversation with one person [using a hearing aid as usual]? Answer: Yes/No

13. Other variables used as covariates? Depressive symptoms (screening test) Cognitive testing Well-being (self-rated general health) Hearing impairment Wearing a hearing aid Hearing problem/background noise Hearing problem/one person Bad eyesight Limitations activities of daily living Having 2 or more chronic diseases Having 2 or more symptoms Mean gross household income Mean net assets Gender Age Country Explanatory variables: Response variables:

14. Prevalence (%) of wearing a hearing aid by country and wave ( cross-sectional, 50+ year olds )

15. Prevalence (%) of fair and poor hearing (vs. excellent, very good, good) by country and wave (cross-sectional, 50+ year olds)

16. Wearing a hearing aid Countrywave 1wave 2 Italy1,71,5 Greece1,81,7 Poland-2,5 Czech Republic-3,3 Spain3,13,5 Belgium3,53,7 France4,14,4 Germany4,6 Total4,74,8 Switzerland5,96,5 Austria5,36,5 The Netherlands6,47,7 Sweden8,39,3 Denmark10,410,3 Prevalence (%) By country and wave Cross-sectional 50+-year olds Weighted data

17. Having fair or poor hearing (vs. excellent, very good, good) Countrywave 1wave 2 Sweden10,69,9 Greece13,910,9 Switzerland11,5 Czech Republic-13,9 Austria14,315,3 Denmark16,815,7 Germany18,017,3 Total17,918,0 The Netherlands19,421,2 Belgium19,021,5 Italy22,3 France22,523,3 Spain23,624,0 Poland-25,7 Prevalence (%) By country and wave Cross-sectional 50+-year olds Weighted data

18. Predicting the probability of hearing impairment having a negative influence on Depressive symptoms Cognitive function Self-rated general health

19. Having fair or poor hearing is significantly associated with poor self-rated general health (Odds Ratio 1.5 [1.4;1.6] p<0.001) poor cognitive function (Odds Ratio 1.4 [1.3;1.5] p<0.001) depressive symptoms (Odds Ratio 1.1 [1.0;1.2] p<0.01)

20. Having fair or poor hearing in conversations with one person + wearing a hearing aid lower risk of developing depressive symptoms (Odds Ratio 0.67 [0.5;0.9] p=0.01.)

21. 2 year follow-up wave 1 ==> wave 2 The effect of developing hearing impairment Of those who develop hearing impairment over 2 years follow-up, 20% will also develop depressive symptoms, - in contrast to only 10% of those who do not report any changes in hearing

22. Conclusion In 13 European countries hearing impairment has a negative outcome on – Depressive symptoms – Cognitive function – Self-rated general health Developing hearing impairment over 2 years increases the risk of having depressive symptoms at 2-year follow-up

23. Future work Look into and describe the effect of hearing impairment on – labor market participation – quality of work – intended early retirement SHARE wave 4 (2010) data: – cross-sectional data from new joining countries: Portugal, Estonia, Luxembourg, Hungary, Ireland – 6 year follow-up from wave 1 (2004)