Exploring the Link Between Hearing Impairment and Depression in Elderly China

Objective Hearing impairment (HI) and depression are prevalent among older adults, yet their association remains underexplored in China. This study investigates the link between depressive symptoms and self-reported HI risk using longitudinal data. Methods Data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS) were examined. Following application of inclusion and exclusion criteria, 4,547 participants from CHARLS and 7,390 from CLHLS were enrolled. Self-reported HI was evaluated using the question: “Do you ever wear a hearing aid? Would you say your hearing is excellent, very good, good, fair, or poor?” Subjective HI was defined as any response other than 'excellent' or 'good' to the hearing question, or reported hearing aid use. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CESD), with participants classified into high- and low-depression groups. Severity of depressive symptoms served as the primary exposure variable. Cox regression, restricted cubic splines, time-dependent ROC curves, and population attributable fraction analyses were employed to assess the association between depressive symptoms and HI, with adjustments for confounders. Results Over an extended follow-up, the low CESD group demonstrated a significantly lower risk of HI compared with the high CESD group (p < 0.001). Higher CESD scores were associated with an increased HI risk in both the CHARLS (HR = 1.68, 95% CI = 1.50–1.88) and CLHLS (HR = 1.59, 95% CI = 1.38–1.83) cohorts. A linear association was identified between CESD scores and HI risk in CHARLS (p for association < 0.001; p for nonlinearity = 0.142) and CLHLS (p for association < 0.05; p for nonlinearity = 0.375). In the CLHLS cohort, gender and alcohol consumption significantly influenced the association between depressive symptoms and HI (p for interaction < 0.05). Population attributable fraction analysis revealed that eliminating the high CESD group could prevent 32.68% of HI cases in CHARLS and 29.20% in CLHLS. Conclusions Depressive symptoms are linearly associated with increased risk of self-reported HI. Targeting alcohol consumption and depression management in older adults may be critical for developing HI prevention strategies. Clinical trial number: This is a retrospective cohort study targeting a population survey, which does not involve clinical trials and does not have clinical trial numbers.