Association between social determinants of health and hearing loss: A cross-sectional study of South African children

Abstract

Abstract Background Approximately 34 million children younger than 15 years have hearing loss worldwide. There is strong and growing evidence of associations between social determinants of health, non-medical factors that influence health outcomes, and disability in general. However, little is known about the social determinants of health and hearing loss in children. We therefore examined parental socioeconomic status (education level, employment status and income level), non-medical determinants of health (rurality, housing, type of toilet, availability of clean drinking water, exposure to cigarette smoke) and hearing loss in children. Methods We used data from a cross-sectional survey conducted between July and December 2022 involving 517 children who underwent hearing testing in South Africa. Sociodemographic data were collected from each participant. Data were analysed using Stata (version 18). Multivariable logistic regression was conducted to test for the association between hearing loss and exposure variables, i.e., non-medical determinants of health and parental socioeconomic status. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to ascertain the odds of hearing loss with exposure variables. Additionally, a two-tailed Student’s t-test was calculated to assess the potential differences in means between groups with respect to exposure variables, with the significance level set at ≤ 0.05. Results Hearing loss was diagnosed in 102 participants (20%), including 57 (56%) females. Exposure to cigarette smoking was associated with hearing loss (OR:3.5; 95%CI:2.2–5.5, P < 0.001). After adjusting for age, sex, and cigarette smoking exposure, staying in a mud-house (OR:2.1, 95%CI:1.4–3.3), lack of clean drinking water (OR:2.2, 95%CI:1.4–3.5; P < 0.001), using pit latrines (OR:5.0, 95%CI:2.1–12.1; P < 0.001), parental unemployment (OR:1.6; 95%CI:1.0–2.6, P = 0.05), and having parents with an annual income <$2882 (OR:12.2, 95%CI:1.6–90.6; P = 0.01) or $2882-$8006 (OR:7.8, 95%CI:2.0–61.9; P = 0.05) were all associated with hearing loss. Conclusions Exposure to cigarette smoking, pit latrine use, lower parental income and lack of clean drinking water were all associated with increased odds of hearing loss. Public Health interventions and policies targeting these social determinants of health are recommended to reduce the burden of hearing loss. Additionally, research to understand the pathophysiology of hearing loss in children exposed to smoking or using pit latrines is recommended.