ImportanceThe risk of developing Parkinson disease (PD) after objective hearing loss is unknown. PD studies using self-reported hearing loss are insensitive, and objective data are lacking.ObjectiveTo examine the association of hearing loss with incident PD in US veterans and its effect modification by well-established prodromal conditions and hearing aids.Design, Setting, and ParticipantsThis cohort study analyzed electronic health record data from the US Department of Veterans Affairs for veterans who had an audiogram from January 1, 1999, to December 30, 2022. Individuals with data missing or a preexisting PD diagnosis were excluded.ExposureAudiogram-confirmed hearing loss.Main Outcomes and MeasuresCumulative incidence of PD was calculated with adjustment for competing risk of death.ResultsAmong 7 296 051 veterans with an audiogram, 3 596 365 were included. They were mostly male (n = 3 452 898 [96%]) and had a mean (SD) age of 67 (10.3) years. A total of 750 010 individuals (20.8%) had normal hearing at the time of audiometry examination; among those with hearing loss, 1 080 651 (30.0%), 1 039 785 (28.9%), 568 296 (15.8%), and 157 623 (4.3%) individuals had mild (20-<35 dB), moderate (35-<50 dB), moderate to severe (50-<65 dB), and severe to profound (65-120 dB) hearing loss, respectively. Age, gender, and smoking history were balanced between all exposed and unexposed groups with further adjustment for race, ethnicity, and frailty. At 10 years after the baseline audiogram, the numbers of additional cases of PD were 6.1 (95% CI, 4.5-7.79, 15.8 (95% CI, 12.8-18.8), 16.2 (95% CI, 11.9-20.6), and 12.1 (95% CI, 4.5-19.6) among veterans with mild, moderate, moderate to severe, and severe to profound hearing loss, respectively, compared with those with normal hearing. When combined with established prodromal conditions, hearing loss was associated with 5.7 (95% CI, 2.2-9.2) additional cases of PD at 10 years compared with either condition alone. With prompt hearing aid dispensation, incident cases of PD decreased by 21.6 cases (95% CI, 19.5-23.6) at 10 years.Conclusions and RelevanceHearing loss appears to be an independent risk factor for later development of PD. Hearing aids attenuate this risk, and therefore widespread screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD. Additional studies are needed to examine the mechanisms underlying the association between hearing loss and PD.

中文翻译：

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听力损失、帕金森病和助听器治疗


重要性客观听力损失后患帕金森病 （PD） 的风险尚不清楚。使用自我报告的听力损失的 PD 研究不敏感，并且缺乏客观数据。目的探讨美国退伍军人听力损失与事故 PD 的相关性及其效果被公认的前驱疾病和助听器改变。设计、设置和参与者该队列研究分析了美国退伍军人事务部对 1999 年 1 月 1 日至 2022 年 12 月 30 日期间有听力图的退伍军人的电子健康记录数据。数据缺失或先前存在 PD 诊断的个体被排除在外。暴露听力图证实的听力损失。主要结局和措施计算 PD 的累积发生率，并调整竞争性死亡风险。结果在 7 296 051 名有听力图的退伍军人中，共纳入 3 596 365 名。他们大多为男性 （n = 3 452 898 [96%]），平均 （SD） 年龄为 67 （10.3） 岁。共有 750 010 例 （20.8%） 在测听时听力正常;在听力损失者中，1 080 651 （30.0%）、1 039 785 （28.9%）、568 296 （15.8%） 和 157 623 （4.3%） 为轻度 （20-<35 dB）、中等 （35-<50 dB）、中度至重度 （50-<65 分贝）和重度至极重度 （65-120 分贝） 听力损失。所有暴露组和未暴露组的年龄、性别和吸烟史均保持平衡，并进一步调整种族、民族和虚弱程度。基线听力图后 10 年，新增 PD 病例数为 6.1 例（95% CI，4.5-7.79、15.8 例（95% CI，12.8-18.8）、16.2 例（95% CI，11.9-20.6）和 12.1 例（95% CI，4.5-19。6） 与听力正常的人相比，轻度、中度、中度至重度和重度至极重度听力损失的退伍军人分别患有轻度、中度、中度至重度听力损失。当与已确定的前驱疾病相结合时，与单独使用任何一种疾病相比，听力损失与 10 年时增加 5.7 例 （95% CI，2.2-9.2） 例 PD 相关。通过及时配发助听器，PD 的发病病例在 10 年时减少了 21.6 例 （95% CI，19.5-23.6）。结论和相关性听力损失似乎是 PD 后期发展的独立危险因素，助听器减轻了这种风险，因此广泛筛查听力损失和适当使用助听器可能会降低 PD 的发生率。