| Cardio-cerebrovascular(CVD)has been the leading cause of total death among urban and rural residents in China;while coronary heart disease(CHD)and stroke are the most serious disease,which effects persons'health and has become a major public health problem.CVD risk factors are overweight and obesity,smoking,alcoholism,insufficient physical activity,unreasonable diet,diabetes,dyslipidemia,air pollution,et al.In addition,recent studies have reported that hearing loss might be related to the incidence and mortality of CHD and stroke.With the acceleration of the aging in Chinese population,there is no large middle-aged and elderly Chinese cohort study to analyze whether age-related hearing loss is increasing the risk of CHD and stroke incidence and mortality.Exploring the relationships of hearing loss severity and the risk of CHD and stroke incidence and mortality could identify high-risk population,early detect CHD and stroke patients,timely warn people and prevent their premature death,which is significant to reduce the CHD and stroke disease burden.We aimed to discuss in four parts based on the Dongfeng-Tongji cohort:firstly,cross-sectional associations of factors and hearing loss,including demographic characteristics,main lifestyle,basic health status and occupational factors;secondly,cross-sectional associations of hearing loss with CHD and stroke and its subtypes;next,prospective relationships of hearing loss with CHD and stroke and its subtypes;finally,prospective relationships of hearing loss with CHD and stroke mortality.Part? Associations of hearing loss with risk factors among middle-aged and elderly populationObjectives:To study the cross-sectional associations of demographic characteristics,main lifestyle,basic health status and occupational factors with hearing loss.Methods:At the first follow-up of Dongfeng-Tongji cohort in 2013,a total of 20587participants finished hearing tests.After excluding persons with missing hearing thresholds at each frequency,20376 subjects were finally included.We used the arithmetic average method to calculate speech-frequency and high-frequency pure tone hearing thresholds in both ears,respectively,which was divided into normal hearing(?25 d B),mild hearing loss(26-40 d B),moderate hearing loss(41-60 d B)and severe hearing loss(>60 d B)according to the World Health Organization(WHO)standards.Multivariate logistic regression models were used to analyze the relationships of demographic characteristics,main lifestyle,basic health status and occupational factors and hearing loss.Results:A total of 19243 subjects were included in the study on the risk factors of hearing loss among middle-aged and elderly population,the average age was 64.6±8.4 years,and 8428 men(43.8%)and 10815 women(56.2%).Speech-frequency normal hearing,mild hearing loss,moderate hearing loss and severe hearing loss were 9524(49.5%),6700(34.8%),2350(12.2%)and 669(3.5%),respectively;high-frequency hearing loss levels were 3331(17.3%),4587(23.8%),6211(32.3%)and 5114(26.6%),respectively.Compared with those aged?60 years,nighttime sleep(7-<8 h)and non-diabetes,participants with age>60 years,nighttime sleep?9 h and diabetes had a higher speech-frequency mild,moderate and severe hearing loss;while compared with below primary school and non-exercise individuals,above junior high school and exercise persons had a lower speech-frequency mild,moderate and severe hearing loss.High-frequency hearing loss was similar to speech-frequency results,and men,smoking and occupational noise>25 years had higher high-frequency hearing loss.In addition,compared with those had no occupational noise exposure,when occupational noise exposure years increased,their speech-frequency and high-frequency hearing thresholds increased;while the longer years of away from occupational noise exposure,the lower increase in speech-frequency and high-frequency hearing thresholds.Conclusion:Age>60 years,men,low education level,lack of exercise,smoking,night sleep?9 h,diabetes and occupational noise exposure>25 years were hearing loss risk factors among middle-aged and elderly Chinese.In addition,the longer years of away from occupational noise exposure,the lower increase in speech-frequency and high-frequency hearing thresholds.Part? Cross-sectional associations of hearing loss with cardio-cerebrovascular diseases prevalenceObjectives:To investigate the associations of hearing loss with prevalent CHD and stroke and its subtypes among middle-aged and elderly Chinese.Methods:At the first follow-up of Dongfeng-Tongji in 2013,after excluding participants with miss hearing threshold at each frequency,conductive hearing loss(otitis media,congenital deafness,infectious deafness and traumatic deafness),drug-induced deafness,sudden deafness and unknown deafness,as well as severe abnormal and missing electrocardiogram(ECG),14755 middle-aged and elderly Chinese were included to analyze the relationships of hearing loss and CHD risk;in addition,the above exclusion criteria except those with severe abnormal ECG,a total of 19238 participants were included to analyze the association of hearing loss and stroke and its subtypes risk.Logistic regression models were used to calculate the odds ratio(OR)and 95%confidence interval(CI)of hearing loss with CHD and stroke and its subtype.Results:In the analysis of hearing loss and CHD and stroke prevalence,compared with normal hearing persons,people with speech frequency severe hearing loss were older,men,lower education level,less exercise and occupational noise exposure;high-frequency hearing loss was similar to speech frequency,and the ratio of drinking and occupational noise exposure was higher.At speech frequency,CHD prevalence normal hearing,mild,moderate and severe hearing loss were 11.5%,19.2%,24.1%and 25.4%,respectively;stroke prevalence were 3.3%,5.1%,6.5%and 10.5%,respectively.At high frequency,CHD prevalence in normal hearing,mild,moderate and severe hearing loss were 6.7%,12.7%,17.6%and 23.5%,respectively;stroke prevalence were 1.9%,3.1%,4.8%and 7.4%,respectively.As hearing loss severity increased,prevalent CHD and stroke and its subtypes risk gradually increased.In analysis of hearing loss and prevalent CHD,both speech-frequency and high-frequency hearing loss showed significant relationships with CHD prevalence.Compared with normal hearing,the OR(95%CI)of speech-frequency mild,moderate and severe hearing loss were 1.19(1.06,1.33),1.18(1.01,1.37),and 1.27(1.00,1.61);high-frequency were 1.34(1.11,1.62),1.37(1.13,1.65)and 1.49(1.22,1.82),respectively(all P trends<0.05).Participants with speech-frequency and high-frequency hearing loss had higher risk of CHD among hyperglycemia and hypertension(all Ptrend<0.05).Meanwhile,most CHD-related clinical testing indicators adverse changes,including glycated hemoglobin,fasting blood glucose,homocysteine,blood creatinine,blood urea nitrogen,red blood cell distribution width and mean platelet volume increased,as well as neutrophil and lymphocyte percentage decreased,were related to increasing severity of speech-frequency and high-frequency hearing loss.In addition,speech-frequency and high-frequency severe hearing loss and overweight,hyperglycemia,hypertension or dyslipidemia had a combined effect on the risk of CHD prevalence.In analysis of hearing loss and prevalent stroke and its subtype,compared with normal hearing,participants having speech-frequency and high-frequency severe hearing loss were significantly associated with the risk of stroke,and its OR(95%CI)were 1.76(1.30,2.38)and 1.39(1.02,1.89),respectively,ischemic stroke had similarly results;while only speech-frequency severe hearing loss was significantly related to the risk of prevalent hemorrhagic stroke(OR=2.23,95%CI:1.09,4.57).Stratified analysis suggested that men,age>65 years,smoking,drinking,diabetes,hypertension,hyperlipidemia and occupational noise expose,the associations of speech-frequency severe hearing loss with prevalent stroke and ischemic stroke were stronger;high-frequency severe hearing loss and prevalent stroke and ischemic stroke had similar results.In addition,speech-frequency and high-frequency severe hearing loss had a combined effect on prevalent stroke with age,diabetes,hypertension or hyperlipidemia.Conclusion:The results suggested a significant relationship of speech-frequency and high-frequency hearing loss severity with prevalent CHD and stroke risk,especially ischemic stroke,among middle-aged and elderly population.Part? Prospective associations of hearing loss with cardio-cerebrovascular diseases incidenceObjective:To analyze hearing loss and incident CHD and stroke and its subtypes among middle-aged and elderly Chinese.Methods:At the first follow-up of Dongfeng-Tongji in 2013,after excluding participants with prevalent stroke,CHD,tumors,severe abnormal ECG,missing hearing thresholds,and conductive hearing loss(otitis media,congenital deafness,infectivity deafness and traumatic deafness),drug-induced deafness,sudden deafness and unknown deafness,13,880 participants were included to analyze the association between hearing loss and incident CHD before December 31,2018;in addition,the above exclusion criteria except those with severe abnormal ECG,13,991 participants were included to analyze the relationship of hearing loss and stroke and its subtypes incidence.Cox regression models were used to calculate the hazard ratio(HR)and 95%CI of hearing loss with CHD and stroke and its subtypes.Results:In the analysis of hearing loss and CHD and stroke incident risk,compared with normal hearing,persons with speech-frequency severe hearing loss were older,men and higher prevalence of diabetes,while lower education levels,lack exercise and lower occupational noise exposure ratio.High-frequency hearing loss had similar results with speech-frequency,participants had higher BMI,smoking,drinking and occupational noise exposure ratio,while hyperlipidemia prevalence was lower.At speech frequency,CHD incidence normal hearing,mild,moderate and severe hearing loss were 16.7%,20.4%,25.1%and 28.6%,respectively,and stroke incidence were 3.1%,4.9%,6.5%and7.4%,respectively.At high frequency,CHD incidence in normal hearing,mild,moderate and severe hearing loss were 12.7%,16.6%,20.5%and 25.5%,respectively;and stroke incidence were 1.5%,3.1%,5.0%and 6.6%,respectively.A total of 13,880 participants were included in hearing loss and CHD analysis,2,662incident CHD.Hearing loss was not significantly associated with incident CHD in the general population;while in men,compared with normal hearing,participants with speech-frequency moderate and severe hearing loss had a significant increase in CHD incidence,and the HR(95%CI)were 1.22(1.03,1.44)and 1.25(0.94,1.66);high-frequency moderate and severe hearing loss also increased risk of incident CHD,and HR(95%CI)were 1.36(1.00,1.85)and 1.42(1.04,1.93)(all P trends<0.05).In addition,the association between speech-frequency moderate hearing loss and incident CHD in men was more obviously in participants aged>65 years,overweight,hypertension,hyperlipidemia and occupational noise exposure;while at high-frequency,the association was more pronounced among those aged?65 years and non-diabetes(all P trends<0.05).The analysis of hearing loss with incident stroke and its subtypes among the 13,991individuals,588 incident stroke(454 ischemic stroke and 134 hemorrhagic stroke).Compared with normal hearing,high-frequency moderate and severe hearing loss had an increase of 27%(95%CI:0.88,1.84),50%(95%CI:1.05,2.14)and 49%(95%CI:1.03,2.16)in stroke.Stratified analysis found high-frequency severe hearing loss were more obviously in stroke among participants with diabetes and hyperlipidemia.Conclusion:Men's increased speech-frequency and high-frequency hearing loss severity had a dose-response association of elevated incident CHD risk.High-frequency hearing loss and incident stroke showed a dose-response relationship in the general population,but speech-frequency and high-frequency different hearing loss levels were not related to incident hemorrhagic stroke.Part? Prospective associations of hearing loss with cardio-cerebrovascular diseases mortalityObjective:To investigate whether there is a causal relationship of hearing loss with CHD and stroke mortality.Methods:At the first follow-up of Dongfeng-Tongji in 2013,after participants with excluding missing hearing threshold,conductive hearing loss(otitis media,congenital deafness,infectious deafness and traumatic deafness),drug deafness,sudden deafness and unknown deafness,a total of 19,243 middle-aged and elderly Chinese were included to analyze hearing loss and the mortality of CHD and stroke before December 31,2018.Cox regression models were used to calculate the risk of hearing loss with CHD and stroke mortality.Results:With speech frequency hearing loss levels increased,age,male ratio,below primary school ratio and diabetes prevalence gradually increased,while the proportion of exercise and occupational noise exposure gradually decreased.High-frequency hearing loss was similar to speech-frequency results,and BMI,smoking,drinking and occupational noise exposure gradually increased,while hyperlipidemia prevalence decreased.CHD mortality was 1.4%and stroke mortality was 0.8%.A total of 19,243 participants in the analysis of hearing loss and CHD mortality,263CHD deaths,compared with normal hearing,participants with speech-frequency severe hearing loss had a higher CHD mortality risk of 69%(HR=1.69,95%CI:1.05-2.72),this association was stronger among participants with age>65 years,overweight,hypertension and hyperlipidemia.In the analysis of hearing loss and stroke mortality among 19243 participants,160stroke deaths,compared with normal hearing,the HR(95%CI)of stroke mortality with speech-frequency mild,moderate and severe hearing loss were 1.61(1.06,2.45),1.60(0.97,2.66)and 3.49(1.97,6.17);and only high-frequency severe hearing loss could increase stroke mortality risk(HR=2.68,95%CI:1.03,6.98).Further stratified analysis found that speech-frequency severe hearing loss was more obviously in stroke mortality among participants with age>65 years,diabetes,hyperlipidemia and occupational noise exposure,while the high-frequency severe hearing loss was stronger in stroke mortality among age>65 years.Conclusion:Sever speech-frequency and high-frequency hearing loss and CHD and stroke mortality;while speech-frequency mild,moderate and severe hearing loss were associated with stroke mortality. |
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