When CKM Syndrome Stage Is Not a Severity Scale: Audiometric Hearing Thresholds in Older U.S. Adults

Objective: To examine whether bilateral four-frequency pure-tone average (PTA4) increased across operational cardiovascular-kidney-metabolic (CKM) stages and assess associations with individual CKM components. Design: Cross-sectional National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 pre-pandemic analysis. Survey-weighted models adjusted for demographics, education, smoking, and noise exposure. Study sample: Adults aged 70-79 years (n = 994); stage analysis n = 285; waist model n = 778. Results: Covariate-adjusted mean bilateral PTA4 thresholds did not increase consistently across stages. No planned Stage 2-4 comparison met the Holm criterion; Stage 4 minus Stage 3 was 4.45 dB HL (95% CI, −0.61 to 9.51; Holm p = 0.246). Stage 2-4-only heterogeneity was not supported (p = 0.197). The five-stage omnibus was significant (p < 0.001), but inference was limited by sparse lower-stage support, including one Stage 0 participant. Waist circumference alone met the nine-test Holm criterion: +1.57 dB HL per 10 cm (95% CI, 0.74 to 2.39; Holm p = 0.00547). Conclusions: Greater waist circumference was associated with higher PTA4, but this cross-sectional association does not establish a hearing benefit from reducing waist circumference. These data do not establish operational CKM stage as a graded indicator of PTA4 in adults aged 70-79 years.