Goulart, Bárbara Niegia Garcia de

Rech, Rafaela Soares

Otology & Neurotology

English

Universidade Federal do Rio Grande do Sul

Comment on “mortality and cause of death in hearing loss participants : a longitudinal follow-up study using a national sample cohort”

Lume 5.8

Downloadedfromhttp://journals.lww.com/otology-neurotologybyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE=on11/06/2020Downloadedfromhttp://journals.lww.com/otology-neurotologybyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE=on11/06/2020Copyright © 2020 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.Letters to the EditorCOMMENT ON ‘‘MORTALITY AND CAUSE OFDEATH IN HEARING LOSS PARTICIPANTS: ALONGITUDINAL FOLLOW-UP STUDY USING ANATIONAL SAMPLE COHORT’’To the Editor: We recently reviewed the article publishedby Kim et al. (1) in the human communication epidemi-ology research group. The study aims to estimate the riskof mortality in subjects with severe and profound hearingloss according to the cause of death. The authors assumethat changes in the auditory system lead to a greater riskof serious falls that lead to death (1).In studies in which the causal chain of diseases andillnesses are analyzed, depending on the basic epistemo-logical and epidemiological framework, it is recom-mended that the links between the exposures and theoutcome studied, as well as the variables related toexposure and outcome even if they are not the objectiveof the study, must be considered in the analysis models(2). Furthermore, considering that the planning of a studyrequires theoretical models defined a priori and based onthe existing literature in addition to the definition of thestatistical analyzes to be performed, including the cova-riables that will be inserted in the analysis models thatwill be performed reduces the probability that relevantvariables are left out of the necessary adjustments forproper testing of the hypotheses on screen (3,4). In thiscase we refer mainly to confounding factors, since notconsidering these can, among others, lead researchers tofind spurious associations (5). Literature research on therelationship between severe and profound hearing lossfrom the age of 40 and over and mortality rates opens arelevant range of possibilities already explored before(6–13) and not explored by the authors in the discussionor even in the fragilities of the study.Analyzing Table 1 of the manuscript, in which theauthors present the characteristics of the studied popu-lation, there is a high proportion of subjects from the ruralarea in both groups of hearing impaired, severe andprofound (59.7 and 65.1%, respectively) (1). The twostudies previously carried out and cited by the authors(Genther et al., 2015) (14) and Karpa et al. (15) havelower hazard ratio and do not present information on theresidence of their population (if rural or from the cities).We think that an important causal factor related tomortality and hearing loss in the researched population,exposure to pesticides and agrochemicals (16–18), wasnot considered by the authors in their analysis and inthe discussion of the data. This is an important andcurrent element of causation of health problems indeath, as highlighted in the literature (19). Despite thefact that modern epidemiology demonstrates that healthtransposes the individual level of understanding of thehealth-disease process, it is also necessary to considerindividual aspects such as the period of acquisition ofhearing loss, whether acquired or congenital, laboraspects and exposure to noise and health-related aspects(5), such as self-perceived health (20), access to healthservices (21), and other associated psychological dis-orders (22,23), as these are related to both exposure andoutcome under study and, although this information wasnot available for the study, it should be considered in thediscussion of the findings.The discussion and conclusions are not fully supportedby the presented methodology and results. Hearing is acomplex system and the relationship between hearingloss and death is possibly not a direct cause. Thus, wehighlight the importance of a critical and cautious read-ing of the data presented, especially in relation to itsapplication in health policies and clinic.Bárbara Niegia Garcia de Goulart, Ph.D.Rafaela Soares Rech, Ph.D.Postgraduate Studies in Epidemiology, UniversidadeFederal do Rio Grande do Sul – UFRGS,Porto Alegre (RS), Brazilbngoulart@gmail.comAuthor contributions: B.N.G.G. and R.S.R. designed,discussed, analyzed, wrote, and reviewed thefinal version of this letter to the editor.Financial support: Conselho Nacional de Desenvolvi-mento Cientı́fico e Tecnológico (CNPq).The authors disclose no conflicts of interest.DOI: 10.1097/MAO.0000000000002708REFERENCES1. Kim SY, Chanyang M, Hyung-Jong K, et al. Mortality and causeof death in hearing loss participants. A longitudinal follow-upStudy Using a National Sample Cohort. Otol Neurotol 2020;4:25–32.2. Rothman KJ, Greenland S, Stat C. Causation and causal inference inepidemiology. Am J Public Health 2005;95:S144–50.3. Rothman KJ. Causes. Am J Epidemiol 1976;104:587–92.4. Rothman KJ, Poole C. A strengthening programme for weakassociations. Int J Epidemiol 1988;17 (suppl):955–9.5. Parascandola M, Weed DL. Causation in epidemiology. J Epide-miol Community Health 2001;55:905–12.6. Talani C, Mäkitie A, Beran M, Holmberg E, Laurell G, Farnebo L.Early mortality after diagnosis of cancer of the head and neck - apopulation-based nationwide study. PLoS One 2019;14:e0223154. 2020, Otology & Neurotology, Inc.Copyright © 2020 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.7. Khoza-Shangase K. Pharmaco-audiology vigilance in the treatmentof adult patients with HIV/AIDS: ototoxicity monitoring protocolrecommendation. Infect Disord Drug Targets 2020;20:33–42.8. Brehmer Y, Kalpouzos G, Wenger E, Lovden M. Plasticity of brainand cognition in older adults. Psychol Res 2014;78:790–802.9. Lin FR, Ferrucci L, An Y, et al. Association of hearing impairmentwith brain volume changes in older adults. NeuroImage 2014;90:84–92.10. McClendon J, Bogdan R, Jackson JJ, Oltmanns TF. Mechanisms ofBlack–White disparities in health among older adults: examiningdiscrimination and personality. J Health Psychol 2019. doi:10.1177/1359105319860180.11. Goman AM, Lin FR. Prevalence of hearing loss by severity in theUnited States. Am J Public Health 2016;106:1820–2.12. Verropoulou G. Specific versus general self-reported healthindicators predicting mortality among older adults in Europe:disparities by gender employing share longitudinal data. Int J PublicHealth 2014;59:665–78.13. Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing lossprevalence and risk factors among older adults in the United States.J Gerontol Med Sci 2011;66A:582–90.14. Genther DJ, Betz J, Pratt S, et al. Association between hearingimpairment and risk of hospitalization in older adults. J Am GeriatrSoc 2015;63:1146–52.15. Karpa MJ, Gopinath B, Beath K, et al. Associations betweenhearing impairment and mortality risk in older persons: theBlue Mountains Hearing Study. Ann Epidemiol 2010;20:452–9.16. Hong O, Chin DL, Kerr MJ. Lifelong occupational exposures andhearing loss among elderly Latino Americans aged 65-75 years. IntJ Audiol 2015;54:S57–64.17. Campo P, Morata T, Hong O. Chemical exposure and hearing loss.Dis Mon 2013;59:119–38.18. Johnson AC, Morata TC. The Nordic Expert Group for criteriadocumentation of health risks from chemicals. 142. Occupationalexposure to chemicals and hearing impairment. Arbete och Hälsa2010;44:1–177.19. Choochouy N, Kongtip P, Chantanakul S, Nankongnab N, SujiraratD, Woskie SR. Hearing loss in agricultural workers exposed topesticides and noise. Ann Work Expo Health 2019;63:707–18.20. Nordvik Ø, Laugen Heggdal PO, Brännström J, Vassbotn F, AarstadAK, Aarstad HJ. Generic quality of life in persons with hearing loss:a systematic literature review. BMC Ear Nose Throat Disord2018;18:1.21. Barnett M, Hixon B, Okwiri N, et al. Factors involved in access andutilization of adult hearing healthcare: a systematic review. Lar-yngoscope 2017;127:1187–94.22. Keidser G, Seeto M, Rudner M, Hygge S, Rönnberg J. On therelationship between functional hearing and depression. Int J Audiol2015;54:653–64.23. Redfors YD, Olaison S, Karlsson J, Hellgren J, Möller C. Hearing-related, health-related quality of life in patients who have undergoneotosclerosis surgery: a long-term follow-up study. Int J Audiol2015;54:63–9.REPLY TO THE COMMENT ON MORTALITYAND CAUSE OF DEATH IN HEARING LOSSPARTICIPANTS: A LONGITUDINAL FOLLOW-UP STUDY USING A NATIONALSAMPLE COHORTIn Reply: We appreciate the comments and agree to theopinion. As we described in the discussion section, it waslimitations of our study that some variables, includingduration of hearing impairment and the exposure topesticides and agrochemicals, could not be considered.The indirect association of hearing impairment withmortality could not be totally excluded in the currentdata (1). The current results demonstrated the rate ofmortality due to all causes were 4.03 times higher insevere hearing impairment patients than the controlparticipants. The causality could not be delineated inthe present study. To attenuate the confounder effects, thecomorbidities were adjusted and the mortality rate wasanalyzed according to the cause of hearing impairment aspresented in Table 4 (1).As pointed by comments, Table 1 described the highproportion of subjects from the rural area in both severeand profound hearing impairment (59.7 and 65.1%,respectively) (1). Because the region of residence couldinfluence to both hearing impairment and mortalitydue to the medical accessibility and environmentalpollutants (2), the control groups were matched forthe region of residence in this study. For the similarreason, the age, sex, and income were matched betweenhearing impairment and control groups. In addition,only the 1.97% (1,020,828/51,826,059) of Koreanwas engaged in agriculture according to the 2018Korean Statistical Information Service (3). Mostprevious reports on the mortality in hearing impairedpatients have limitations on the possible confoundereffects due to the unconcerned environmental factors(4,5).The heterogeneous types and durations of hearingimpairment is another shortcoming of the presentstudy. To attenuate the differences from the degreeof hearing impairments, this study used the hearinghandicap criteria of Korea. The potential relationsbetween hearing impairment and mortality were dis-cussed and these need to be tested in future randomizedcohort study considered these possible confounders.However, the current study was in line with otherstudies suggested the contribution of hearing impair-ment of mortality and improved the previous findingsby analyzed according to the cause of mortality.Although a few possible confounders was existedand the direct impact of hearing impairment onmortality could not be concluded, this study presentedthe higher rate of mortality in hearing impairmentpatients compared with control group, which mightbe clinically meaningful.So Young Kim, M.D., Ph.D.Department of Otorhinolaryngology–Head & NeckSurgery, CHA Bundang Medical CenterCHA University, Seongnam, Republic of Koreapupen@naver.comHyung-Jong Kim, M.D., Ph.D.Department of Otorhinolaryngology–Head & NeckSurgery, Hallym University College of MedicineAnyang, Republic of KoreaLETTERS TO THE EDITOR 861Otology & Neurotology, Vol. 41, No. 6, 2020

https://lume.ufrgs.br/bitstream/10183/216597/1/001119410.pdf

Comment on “mortality and cause of death in hearing loss participants : a longitudinal follow-up study using a national sample cohort”

Abstract

Similar works

Full text

Available Versions

Universidade Federal do Rio Grande do Sul

Lume 5.8