Non-Medical COVID-19 Impacts and Hearing Status: A Global Study of Differential Health Impact Among Deaf, Hard of Hearing, and Hearing Populations

Background

Deaf and hard-of-hearing (HoH) experienced complex challenges during the COVID-19 pandemic, including obscured visual communication from mask mandates, inaccessible public health messaging, and inadequate interpreter availability. We examined whether hearing status predicted non-medical COVID-19 impact on a global level.

Methods

We conducted a nested cross-sectional analysis within a global study collecting data across two waves (April–May 2020 and July–August 2022) from 184 countries. Participants (N=7,998) were categorized as Deaf (n=304), Hard of Hearing (HoH; n=951), or Hearing (n=6,743). The primary outcome was a composite COVID-related non-medical Personal Impact T-Score derived from 14 items across employment, resource access, and healthcare domains. Multinomial logistic regression models progressively adjusted for demographic, structural, and psychosocial variables.

Results

Deaf participants reported substantially higher rates of pandemic-related job loss (28.9% vs. 9.6% hearing), healthcare cancellations (39.9% vs. 24.6%), and inability to obtain basic supplies. Over half (55.9%) of Deaf participants scored above the median composite impact index, compared to 39.2% of hearing participants. In the fully adjusted model, Deaf status remained an independent predictor of high non-medical impact (aOR=1.6, 95% CI: 1.1–2.4). HoH status showed no statistically significant difference from hearing participants in any model.

Conclusions

People identifying as Deaf experienced significant disparities during COVID-19 when compared with HoH or hearing people, driven by language access barriers and institutional exclusion rather than hearing loss per se. These experiences underscore the importance for systemic interventions centering on accessible communication, Deaf-centered needs, and reducing audism in Deaf-hearing interaction.

Strengths and limitations of this study

• Data were collected across two pandemic waves (April–May 2020 and July–August 2022) from 184 countries, allowing us to analyze hearing status on a global level, beyond any single national context or health system.

• The survey was deployed in multiple spoken languages and in American Sign Language (video) alongside written English, and the investigator team included Deaf researchers, supporting direct and accessible participation by Deaf communities rather than reliance on hearing-mediated proxies.

• The composite non-medical impact score was constructed using an established psychometric method with a defined item-retention criterion, and multinomial regression models were progressively adjusted for demographic, structural, and psychosocial variables.

• Participants were recruited through non-probability convenience sampling via social media and Amazon Mechanical Turk, so the sample is not population-representative and is subject to self-selection and coverage bias.

• Hearing status was self-reported and several distinct self-identified categories were consolidated into three groups (Deaf, Hard of Hearing, Hearing), which could mask heterogeneity within these identities.