# Determining the Association Between Hearing Disability and Injury Risk in Older Adults Using Propensity Score Matching: Quasi-Experimental Study

## TL;DR

This study finds that older adults with hearing disability are at higher risk of injury, with more severe hearing loss increasing the risk further.

## Contribution

The study uses propensity score matching to establish a causal link between hearing disability and injury risk in older adults.

## Key findings

- Hearing-disabled older adults had a 21% higher risk of injury admission compared to non-disabled peers.
- The risk increased with the severity of hearing disability and varied by injury site.
- Propensity score matching successfully balanced baseline characteristics between groups.

## Abstract

With rapid population aging, both traumatic injuries and hearing disability have become increasingly prevalent among older adults. Hearing disability may increase vulnerability to injury through impaired balance, reduced environmental awareness, and functional limitations; however, longitudinal evidence examining the association between hearing disability and injury risk remains limited.

This study aimed to examine the association between hearing disability and the risk of injury among older adults using a quasi-experimental design with propensity score matching (PSM).

This population-based cohort study included individuals aged 60 years and older with hearing disabilities and a matched control group without disabilities using data from the National Health Insurance Service–Senior cohort from 2008 to 2019. Injury admission, defined using International Classification of Diseases codes S00 to S99, was the primary outcome. A quasi-experimental design was applied using PSM at a 1:3 ratio to balance baseline characteristics between the hearing-disabled and nondisabled groups. Cox proportional hazard regression models adjusted for all covariates were used to estimate hazard ratios. Sensitivity analyses were conducted according to disability severity and injury site.

The total number of participants was 43,944, with 10,986 (25%) in the hearing-disabled group and 32,958 (75%) in the nondisabled group, thus confirming a 1:3 matching ratio. The PSM results showed that the standardized mean difference values for all covariates were below the absolute value of 0.1, thus indicating that PSM was successfully performed. The incidence of injury admissions was higher in the hearing-disabled group (1567/10,986, 14.3% of patients) than in the nondisabled group (3966/32,958, 12%), and this difference was statistically significant (P<.001). During the follow-up period, older adults with hearing disability had a significantly higher risk of injury admission compared with those without hearing disability (hazard ratio=1.21, 95% CI 1.14‐1.28; P<.001). The association was stronger among individuals with more severe hearing disability and varied by injury site.

Hearing disability in older adults is independently associated with increased injury admission risk, with greater severity conferring a higher risk and variation by injury site. Interventions such as hearing aid provision, targeted traffic safety measures, and enhanced community and family support are warranted to mitigate this burden.