Epidemiology and risk factors of hearing loss in thyroid eye disease in the United States: A retrospective study of MarketScan® data

Background Large-scale studies characterizing hearing loss among patients with Graves disease (GD) and thyroid eye disease (TED) in the United States are lacking. This study aimed to quantify hearing loss incidence, prevalence, and risk in this population. Methods Retrospective study of Merative™ MarketScan® Research Databases (2014–2019) data including individuals aged ≥ 18 years with TED (≥ 1 GD diagnosis and ≥ 1 eye sign/symptom within 12 months), GD (≥ 2 outpatient [≥ 30 days apart]/≥1 inpatient GD diagnoses), or in the general population (GP). Index date was the latter of first GD diagnosis or eye sign/symptom for the TED cohort, the first GD diagnosis for the GD cohort, and the first eligible claim for the GP (baseline: 12 months pre-index; follow-up: from index until hearing loss, disenrollment, death, or data end). Cox models estimated unadjusted/adjusted hazard ratios (HRs) controlling for patient characteristics; time-to-event outcomes were described using Kaplan-Meier methods. Outcomes included incidence, cumulative incidence, prevalence, and HR for hearing loss (identified by ICD-10-CM codes as a composite of conductive hearing loss, sensorineural hearing loss [SNHL], mixed conductive and SNHL, age-related hearing loss). Outcomes were standardized to the 2020 US population by age and sex. Results Overall, 20,493,563 (TED: 38,723; GD: 171,831; GP: 20,283,009) patients were included. Measures of hearing loss were highest in TED (incidence: 142.2 per 10,000 person-years; cumulative incidence: 2.8%; prevalence: 4.6%) versus GD (92.0; 2.0%; 3.0%) and GP (67.6; 1.6%; 2.2%). SNHL was the most frequent subtype. TED showed increased unadjusted risk versus GP (HR 2.6; 95% confidence interval [CI], 2.5–2.8), persisting after adjustment (HR 1.6; 95% CI, 1.5–1.7) with a 60% higher risk of hearing loss. Cumulative incidence increased with age, with patients with TED having higher rates than those with GD or in the GP (18–35 years: 0.8%, 0.4%, and 0.3% for TED, GD, and GP; ≥86 years: 11.5%, 8.9%, and 7.3%). Cumulative incidence was higher among males than females (TED: 4.3% vs. 3.0%; GD: 2.5% vs. 2.0%; GP: 1.6% vs. 1.3%). Conclusions TED and GD are independently associated with high rates of hearing loss diagnosis, supporting their recognition as systemic autoimmune diseases with auditory implications.