(112) Health Insurance, Household Savings, and Self-Reported Hearing in U.S. Adults: NHANES 2021-2023

Introduction: Hearing-health disparities are often attributed to socioeconomic disadvantage, yet the relative roles of health-insurance coverage versus accumulated financial resources remain unclear. We examined whether health-insurance coverage and household savings were independently associated with self-reported hearing status in U.S. adults.

Methods: This cross-sectional database study analyzed National Health and Nutrition Examination Survey data from August 2021 through August 2023. Adults aged ≥20 years with complete data on hearing status, insurance coverage, household savings, and covariates were included from a nationally representative U.S. sample. No interventions were performed. The primary outcome was self-reported hearing status, modeled as an ordered variable. Primary independent variables were health-insurance coverage and household savings category. Survey-weighted ordinal logistic regression adjusted for age, sex, race/ethnicity, education, and income-to-poverty ratio.

Results: Among 6,319 adults included, mean age was 46±17 years and 51% were female. After adjustment, health-insurance coverage was not significantly associated with self-reported hearing status (adjusted odds ratio [aOR] ≈1.07; 95% CI 0.90–1.28). Higher household savings category was associated with increased odds of reporting worse hearing (aOR per category ≈1.27; 95% CI 1.12–1.43). Age demonstrated a strong association with worse hearing (aOR per year ≈1.04). Female sex, higher educational attainment, and higher income-to-poverty ratio were associated with better reported hearing.

Conclusions: In this nationally representative sample, health-insurance coverage was not independently associated with self-reported hearing status after accounting for demographic and socioeconomic factors. Household savings showed a modest association with worse perceived hearing, likely reflecting age-related accumulation rather than contemporaneous socioeconomic advantage. Age and broader socioeconomic factors appear to be the dominant correlates of perceived hearing health.