March 03, 2025 | News | Interview

Age-related Hearing Loss in Europe

Interview with Donata Stonkute and Yana C. Vierboom on educational inequalities and regional differences

Hearing loss affects one in five adults in Europe and is associated with negative health outcomes such as dementia. A recent study by the Max Planck Institute for Demographic Research (MPIDR) examines the influence of education on the prevalence of hearing loss across different European populations. Donata Stonkute, a researcher at MPIDR, and Yana Vierboom (Princeton University) found that educational inequalities in hearing loss vary by age, gender and region.

Researchers at the Max Planck Institute for Demographic Research (MPIDR) and Princeton University found that among women aged 50-64, those with less education were more than three times more likely to report hearing loss. © istockphoto.com / solidcolours

The prevalence of self-reported hearing loss increases with age and is higher among men than women. People with lower levels of education are at higher risk of hearing loss, especially in Southern and Eastern Europe. Among women aged 50-64, those with a low level of education are more than three times as likely to report hearing loss as those with a high level of education, especially in Southern and Eastern Europe.

The discrepancy between the prevalence of hearing loss and the use of hearing aids is particularly pronounced across different regions. Northern Europe leads the way in hearing aid uptake, while Southern and Eastern Europe lag far behind. In these regions, fewer than two in ten people who are eligible for hearing aids actually use them.

The study shows the need for targeted action to achieve more equitable hearing health in Europe. Access to hearing aids and services needs to be improved in all regions of Europe, though particularly in the South and East. The Nordic countries demonstrate the untapped potential to improve healthy ageing in Europe.

Donata Stonkute. © MPIDR/Schulz

Donata Stonkute

Donata Stonkute is currently doctoral student at the Laboratory of Population Health at the Max Planck Institute for Demographic Research (MPIDR) in Rostock.

Yana C. Vierboom © MPIDR

Yana C. Vierboom

Yana Vierboom is currently researcher at the Office of Population Research at Princeton University, USA.

Interview

Yana C. Vierboom (YCV): Before we begin, it is important to note that in our paper, we try to distinguish between age-related hearing loss and deafness/hearing loss that’s present at much younger ages. People who are born deaf or lose their hearing at young ages can live full and fulfilling lives, both with and without hearing devices and especially so with exposure to sign languages. Losing hearing at more advanced ages, however, can be a very destabilizing experience for an older person that may deeply affect their wellbeing. It’s this latter experience that we hoped to study in our paper.

Donata Stonkute (DS): Therefore, in our paper we have focused on self-reported hearing loss, which we believe is a better reflection of the unmet expectations of hearing that people wish for but do not experience as compared to objective measures.

What are the biggest barriers to hearing impaired?

DS: I would name two main barriers to addressing age-related hearing loss. The first is acceptance, as many people may resist acknowledging their hearing loss due to stigma or fear of aging. This can delay help-seeking behavior and prevent individuals from seeking treatment. The second barrier arises after the decision to seek treatment, particularly related to service delivery. In some European countries, individuals face long waiting times for hearing aids, often several months or even years, while others can receive them immediately. Financial coverage is inconsistent; in some countries, hearing aids are fully covered by insurance, but in others, individuals must pay out-of-pocket, which can be a significant burden. The need for specialized batteries, which usually have to be replaced every week or so, often only available in limited locations, adds another layer of difficulty. For instance, one colleague mentioned her mother needs to travel 200 kilometers to get batteries. Together, these factors create significant obstacles to ensuring consistent access to hearing aids and their continuous use.

Also an important side note – tools like sound amplification devices can help ease discomfort only in some, more controlled social environments. In loud environments, background noise can interfere with speech clarity, and the sound amplification may not be sufficient to overcome the high volume of surrounding sounds. So they’re not really a “fix” for hearing loss, but a tool.

What is the average age at which a person begins to experience hearing loss?

DS: When we talk about age-related hearing loss, the incidence starts to be noticeable around the age of 60 and peaks between the ages of 70 and 80.

What did you focus on in your work?

DS: Educational gradients in health outcomes are commonly observed, with individuals with lower education levels being more susceptible to health impairments, while those with higher education are often more protected. However, the protective effect of education can vary across different cultural, healthcare system and policy contexts, as well as between men and women. What was not yet understood, and what we focused on in this work, is how this variation manifests specifically in hearing loss and hearing aid uptake.

What was your main motivation for looking at this?

YCV: Age-related hearing loss is in many ways an invisible disability that can significantly impact an older person’s quality of life. We know that social isolation is a problem for many older adults and hearing loss likely plays a part in that. Maybe it’s no longer being able to talk on the phone, not following conversations at a dinner table, having to quit the weekly pétanque games, no longer babysitting because it's too hard to understand the grandkids’ chattering, and so on. Research has also found a link between hearing loss and dementia.

So for many people with age-related hearing loss, identification and treatment can make a huge difference.

I myself became fully deaf in my early thirties. While a cochlear implant has restored some of my access to sound, I’m also gaining proficiency in American Sign Language—an incredible language that has opened up a whole new world for me. The experience of losing my hearing at a young(ish) age made me wonder what it must be like for older adults who might not easily learn a sign language (or whose friends and family can’t/won’t).

DS: As Yana mentioned, hearing loss is considered an important risk factor for dementia. Hearing loss can lead to social withdrawal, as individuals may struggle to engage in conversations and gradually stop attending social events. Over time, social isolation can lead to cognitive impairment as people are not cognitively stimulated and challenged. While cognitive changes are harder to observe and test compared to physical (body) changes, this is one of several existing hypotheses. However, medical imaging studies already suggest that structural and functional brain changes occur in individuals with age-related hearing loss.

Importantly though, age-related hearing loss is a modifiable risk factor. Unlike the immutable characteristics we’re born into or the age we inevitably progress to, we can change the effects of hearing loss through early intervention, treatment and the use of hearing aids. In order to do so, it was vital to identify the most vulnerable European regions and social groups, which motivated this paper.

What data did you use? Why did you choose Europe?

DS: The study of European regions is of particular value due to the diverse range of welfare regimes that Europe encompasses, even within the context of the European Union (EU). While the EU promotes certain common policies, significant variations in healthcare systems, social support structures and access to resources persist across different countries. This makes Europe an ideal setting for testing the institutional theory of welfare state effects on the distribution of population health, which is the primary focus of my broader research.

We used publicly available data from Survey of Health, Ageing and Retirement in Europe (SHARE), which is specifically designed to study health outcomes, among other things, of populations aged 50 and over.

Hearing loss and hearing aid use across age by education and gender. Hearing loss is measured in the total population, whereas hearing aid use is measured among those eligible for hearing aids. The latter group is defined as individuals who either report using hearing aids or rate their hearing as less than good. © MPIDR

So, what are the findings of your paper?

DS: The relative differences in hearing loss based on education are more pronounced at ages when age-related hearing loss begins to manifest (50-65). However, these differences subsequently decrease, particularly among women. This could be indicative of a delay in the onset of age-related hearing loss among highly-educated individuals, although this is not directly measured in our study.

While having a higher education does not strongly predict whether people who need hearing aids will use them, other factors, like where someone lives, are very important. For example, in Northern Europe, hearing aid use is more widespread, leading to lower rates of self-reported hearing loss. In Eastern and Southern Europe, the opposite is true - weak hearing aid uptake is associated with high prevalence of hearing loss.

Why do you think men are more likely to be hearing impaired?

YCV: So basically, males are more likely to have any hearing loss, are younger at onset of that hearing loss, and have more severe levels of hearing loss. And why is a great question with many answers. Some of it is biological. For example, the female hormone estrogen is protective against age-related hearing loss. And the inner ear structure actually differs for people born male vs. female. And then some of it is sociological, too. Men tend to have greater exposure to loud noises. They work noisier jobs. Men prefer to listen to music through their headphones at louder volumes than women. Teasing apart these many different factors into distinct componenets is challenging.

DS: Great summary by Yana. I would just add that although we measured self-reported hearing loss and the patterns observed are consistent with other studies combining all types of hearing loss, there is strong evidence that certain types of hearing loss (low frequency) are more prevalent in women. The reasons for sex/gender differences, as Yana mentioned, are both biological - hormones, genes, physiological differences - and social - health behaviors such as smoking are more common among men, auditory hazards (noise and ototoxic chemicals) - are common in male-dominated occupations, etc..

How does higher education help maintain good hearing?

YCV: Our findings aren’t causal. We don’t know that education leads to good hearing. We just know that education is associated with better hearing. Belonging to a higher socioeconomic group is also associated with a lot of privileges, including more financial resources, access to better medical care, etc. So, it’s hard to say. But it’s interesting that the prevalence of hearing loss among comparable education groups varies across European regions.

DS: Indeed, we did not test for mechanisms linking education and hearing, thus how is speculative, even though based on prior research. Besides points already mentioned by Yana, I would add occupation, as it is also highlighted by WHO’s World Report on Hearing. Occupations which present significant risks of both noise and chemical exposure are frequently associated with manual labor, a sector in which individuals with a lower level of education are found in significant numbers.

What needs to change to improve the situation in these regions?

DS: Faster and cheaper access to hearing aids and efforts to support continuous use are key. Even a simple policy change – such as scheduling a follow-up audiologist appointment during the initial fit of the device to address common issues like irritation and sound distortion – could significantly improve situation in more affected regions.

The reduction of educational inequalities represents a more challenging task. Simply promoting higher education will not necessarily decrease disparities and may even marginalize smaller, underrepresented groups. Instead, strengthening occupational safety measures, promoting healthy lifestyles, and informing healthcare practitioners about vulnerable populations may be more effective.

Hearing loss is associated with adverse health effects such as dementia, making hearing care a crucial factor for healthy ageing. Given the importance, it is surprising that this topic has been widely overlooked and that we lacked a foundational understanding of hearing loss and hearing aid use in Europe. While the present study yielded some essential statistics, further research is undoubtedly required. As the earlier discussion on the protective effects of education against hearing loss highlighted, additional research could benefit from investigating the mediating effects of financial resources or occupational risks.