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Ferrucci L.,U.S. National Institute on Aging | Thorpe R.,Johns Hopkins Center for Health Disparities Solutions
JARO - Journal of the Association for Research in Otolaryngology | Year: 2012

Epidemiologic studies of hearing loss in adults have demonstrated that the odds of hearing loss are substantially lower in black than in white individuals. The basis of this association is unknown. We hypothesized that skin pigmentation as a marker of melanocytic functioning mediates this observed association and that skin pigmentationis associated with hearing loss independent of race/ethnicity. We analyzed cross-sectional data from1,258 adults (20-59 years) in the 2003-2004 cycle of the National Health andNutritional Examination Survey who had assessment of Fitzpatrick skin type and pure-tone audiometric testing. Audiometric thresholds in the worse hearing ear were used to calculate speech- (0.5-4 kHz) and high-frequency (3-8 kHz) pure-tone averages (PTA). Regression models were stratified by Fitzpatrick skin type or race/ethnicity to examine the association of each factor with hearing loss independent of the other.Models were adjusted for potential confounders (demographic, medical, and noise exposure covariates). Among all participants, race/ethnicity was associated with hearing thresholds (black participants with the best hearing followed by Hispanics and then white individuals), butthese associations were not significant in analyses stratified by skin color. In contrast, in race-stratified analyses, darker-skinned Hispanics had better hearing than lighterskinned Hispanics by an average of ?2.5 dB hearing level (HL; 95% CI, ?4.8 to ?0.2) and ?3.1 dB HL (95% CI, ?5.3 to ?0.8) for speech and high-frequency PTA, respectively. Associations between skin color and hearing loss were not significant in white and black participants.Our results demonstrate that skin pigmentation is independently associated with hearing loss in Hispanics and suggest that skin pigmentation as a marker of melanocytic functioning may mediate the strong association observed between race/ethnicity and hearing loss. © 2011 Association for Research in Otolaryngology.

Lin F.R.,Johns Hopkins Medical Institutions | Thorpe R.,Johns Hopkins Center for Health Disparities Solutions | Gordon-Salant S.,University of Maryland University College | Ferrucci L.,U.S. National Institute on Aging
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2011

Background. Hearing loss has been associated with cognitive and functional decline in older adults and may be amenable to rehabilitative interventions, but national estimates of hearing loss prevalence and hearing aid use in older adults are unavailable. Methods. We analyzed data from the 2005-2006 cycle of the National Health and Nutritional Examination Survey, which is the first cycle to ever incorporate hearing assessment in adults aged 70 years and older. Audiometry was performed in 717 older adults, and data on hearing aid use, noise exposure, medical history, and demographics were obtained from interviews. Analyses incorporated sampling weights to account for the complex sampling design and yield results that are generalizable to the U.S. population. Results. The prevalence of hearing loss defined as a speech frequency pure tone average of more than 25 dB in the better ear was 63.1% (95% confidence interval: 57.4-68.8). Age, sex, and race were the factors most strongly associated with hearing loss after multivariate adjustment, with black race being substantially protective against hearing loss (odds ratio 0.32 compared with white participants [95% confidence interval: 0.19-0.53]). Hearing aids were used in 40.0% (95% confidence interval: 35.1-44.8) of adults with moderate hearing loss, but in only 3.4% (95% confidence interval: 0.8-6.0) of those with a mild hearing loss. Conclusion. Hearing loss is prevalent in nearly two thirds of adults aged 70 years and older in the U.S. population. Additional research is needed to determine the epidemiological and physiological basis for the protective effect of black race against hearing loss and to determine the role of hearing aids in those with a mild hearing loss. © The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Purnell T.S.,Johns Hopkins Medical Institutions | Powe N.R.,San Francisco General Hospital | Troll M.U.,Johns Hopkins Medical Institutions | Wang N.-Y.,Johns Hopkins Medical Institutions | And 4 more authors.
Clinical Transplantation | Year: 2013

Background: Reasons for US racial-ethnic minority ESRD patients' reported difficulties identifying live kidney donors are poorly understood. Methods: We conducted a national study to develop scales measuring willingness to donate live kidneys among US adults (scores ranged from 0 [not willing] to 10 [extremely willing]), and we tested whether racial-ethnic differences exist in willingness to donate. We also examined whether clinical, sociodemographic, and attitudinal factors mediated potential racial-ethnic differences in willingness. Results: Among 845 participants, the majority were extremely willing to donate to relatives (77%) while fewer than half were extremely willing to donate to non-relatives (18%). In multivariable linear regression analyses, willingness to donate varied by race-ethnicity and recipient relationship to the donor. African Americans were less willing to donate to relatives than whites (β: -0.48; 95% CI [Confidence Interval]: -0.94 to -0.17; p = 0.04), but these differences were eliminated after accounting for socioeconomic factors, medical trust, and concerns about burial after death. There were no differences in willingness to donate between Hispanics and whites. Conclusions: African Americans' burial concerns, medical trust, and socioeconomic factors explained differences in their willingness to donate to relatives, suggesting efforts to address these barriers may enhance rates of live kidney donation in this group. © 2013 John Wiley & Sons A/S.

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