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There are limited population-based studies of central auditory processing (CAP). We aimed to determine the relationship between CAP measures and perceived hearing difficulty (PHD) despite normal pure-tone audiometry in an African-American population.Cross-sectional.Jackson Heart Study (JHS), Jackson, MS.Participants of an African-American cohort (26% men; age 54.2, standard deviations [SD] 9.2) who self-reported hearing difficulty despite normal hearing sensitivity defined as audiometric pure-tone average (PTA-4: average of 500, 1000, 2000, and 4000 Hz) less than or equal to 25 dBHL (n = 911) or across all tested frequencies (PT-AF: 250-8000 Hz) less than or equal to 25 dBHL (n = 516).The Quick Speech-in-Noise (QuickSIN) and Dichotic Digits, Double Pairs (DDT2) tests were used to assess CAP. Logistic regression was used to examine the association between measures of CAP and PHD; adjusted for age, sex, education, and pure tone audiogram.PHD was present in 251 (28%) and 137 (27%) of participants using the PTA-4 and PT-AF models, respectively. Fully adjusted regression models revealed that each one-point increase in QuickSIN increased the odds of reporting PHD by 13.7% (odds ratio [OR] 1.14, p 0.01, 95% CI: 1.08, 1.19) using the PTA-4 model and 15.0% (OR 1.15, p 0.01, 95% CI: 1.08, 1.23) using the PT-AF model. For DDT2 testing, each 1% reduction in score, increased the odds of reporting PHD by 7.7% (OR 0.92, p 0.01, 95% CI: 0.88, 0.97) in a fully adjusted PTA-4 model and 6.6% (OR 0.93, p = 0.04, 95% CI: 0.87, 0.99) in the PT-AF model.CAP deficits were associated with increased odds of PHD in normal hearing participants within the JHS cohort.

BackgroundThe homeless population is aging, with early onset of cognitive and functional impairments. It is unclear whether older homeless adults receive caregiving assistance that could prevent long-term disability.ObjectiveWe describe characteristics of older homeless-experienced adults with caregiving need and determine factors associated with having unmet need.Design and participantsCross-sectional analysis of a longitudinal study, Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME), examining health, life course events, and functional status among older homeless-experienced (i.e., currently and recently homeless) adults. We recruited 350 homeless adults (July 2013-June 2014) and an additional 100 (August 2017 to July 2018) in Oakland, California; this study includes 303 participants who completed caregiving interviews.MeasurementsWe defined caregiving need as difficulty with activities of daily living (ADLs), instrumental activities of daily living (IADLs), falls, Short Physical Performance Battery (SPPB) score < 10, or Modified Mini-Mental State (3MS) exam impairment. We defined unmet need as having caregiving need and reporting not receiving caregiving assistance in the last 6 months. Using logistic regression, we analyzed associations between respondent characteristics and unmet caregiving need.ResultsAmong 303 participants, the mean age was 61.3 ± 5.0 years; 73% were men and 82% were Black. Eighty-one percent had caregiving needs, and in 82% of those, their caregiving needs were unmet. Better self-rated health (AOR 2.13, CI [1.02-4.46], p = 0.04) and being a man (AOR 2.30, CI [1.12-4.69], p = 0.02) were associated with higher odds of unmet need. Moderate or high-risk substance use (AOR 0.47, CI [0.23, 0.94], p = 0.03) was associated with lower odds of unmet need.ConclusionsOlder homeless-experienced adults have high prevalence of unmet caregiving need. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term-care needs due to untreated disabilities.

ImportanceThe population of homeless older adults is growing and experiences premature mortality. Little is known about factors associated with mortality among homeless older adults.ObjectiveTo identify the prevalence and factors associated with mortality in a cohort of homeless adults 50 years and older.Design, Setting, and ParticipantsIn this prospective cohort study (Health Outcomes in People Experiencing Homelessness in Older Middle Age [HOPE HOME]), 450 adults 50 years and older who were homeless at baseline were recruited via venue-based sampling in Oakland, California. Enrollment occurred in 2 phases, from July 2013 to June 2014 and from August 2017 to July 2018, and participants were interviewed at 6-month intervals.ExposuresBaseline and time-varying characteristics, including sociodemographic factors, social support, housing status, incarceration history, chronic medical conditions, substance use, and mental health problems.Main Outcomes and MeasuresMortality through December 31, 2021, based on state and local vital records information from contacts and death certificates. All-cause mortality rates were compared with those in the general population from 2014 to 2019 using age-specific standardized mortality ratios with 95% CIs.ResultsOf the 450 included participants, median (IQR) age at baseline was 58.1 (54.5-61.6) years, 107 (24%) were women, and 360 (80%) were Black. Over a median (IQR) follow-up of 55 (38-93) months, 117 (26%) participants died. Median (IQR) age at death was 64.6 (60.3-67.5) years. In multivariable analyses, characteristics associated with mortality included a first episode of homelessness at 50 years and older (adjusted hazard ratio [aHR], 1.62; 95% CI, 1.13-2.32), homelessness (aHR, 1.82; 95% CI, 1.23-2.68) or institutionalization (aHR, 6.36; 95% CI, 3.42-11.82) at any follow-up compared with being housed, fair or poor self-rated health (aHR, 1.64; 95% CI, 1.13-2.40), and diabetes (aHR, 1.55; 95% CI, 1.06-2.26). Demographic characteristics, substance use problems, and mental health problems were not independently associated. All-cause standardized mortality was 3.5 times higher (95% CI, 2.5-4.4) compared with adults in Oakland. The most common causes of death were heart disease (n = 17 [14.5%]), cancer (n = 17 [14.5%]), and drug overdose (n = 14 [12.0%]).Conclusions and RelevanceThe cohort study found that premature mortality was common among homeless older adults and associated factors included late-life homelessness and ongoing homelessness. There is an urgent need for policy approaches to prevent and end homelessness among older adults in the US.

There is no clear consensus on a lower cutoff value for normal left ventricular ejection fraction (EF) and the prognostic implications of low normal EF (LNEF) are poorly understood, particularly in Blacks. Therefore, we investigated the association of LNEF and incident heart failure (HF) in a community-based cohort of Blacks. We studied 3,669 participants (mean age 54 years, 63% women) of the Jackson Heart Study without prevalent HF or coronary heart disease (CHD). Participants were divided into three groups: (1) Reduced EF (

OBJECTIVES To evaluate the relationships among the overall cardiovascular health scoring tool, Life's Simple 7 (LS7), and hearing in an African-American cardiovascular study cohort. METHODS Using the Jackson Heart Study's cohort of African Americans, the relationships between the LS7 scoring metric and hearing of 1314 individuals were assessed. Standard audiometric data was collected and hearing loss was defined as a four-frequency average of 500, 1000, 2000, and 4000 Hz greater than 25 dBHL (PTA4). Measures of reported tinnitus and dizziness were also collected. The LS7 scoring tool, which consists of seven individual categories (abstinence from smoking, body mass index, physical activity, healthy diet, total cholesterol

Previous research has shown that genes play a substantial role in determining a person’s susceptibility to age-related hearing impairment. The existing studies on this subject have different results, which may be caused by difficulties in determining the phenotype or the limited number of participants involved. Here, we have gathered the largest sample to date (discovery n = 9,675; replication n = 10,963; validation n = 356,141), and examined phenotypes that represented low/mid and high frequency hearing loss on the pure tone audiogram. We identified 7 loci that were either replicated and/or validated, of which 5 loci are novel in hearing. Especially the ILDR1 gene is a high profile candidate, as it contains our top SNP, is a known hearing loss gene, has been linked to age-related hearing impairment before, and in addition is preferentially expressed within hair cells of the inner ear. By verifying all previously published SNPs, we can present a paper that combines all new and existing findings to date, giving a complete overview of the genetic architecture of age-related hearing impairment. This is of importance as age-related hearing impairment is highly prevalent in our ageing society and represents a large socio-economic burden.

Background Although Black adults are more likely to die from coronary heart disease (CHD) compared with White adults, few studies have examined the relationship between cigarette smoking and CHD risk among Black adults. We evaluated the relationship between cigarette smoking, incident CHD, and coronary artery calcification in the JHS (Jackson Heart Study). Methods and Results We classified JHS participants without a history of CHD (n=4432) by self‐reported baseline smoking status into current, former (smoked at least 400 cigarettes/life) or never smokers at baseline (2000–2004). We further classified current smokers by smoking intensity (number of cigarettes smoked per day [1–19 or ≥20]) and followed for incident CHD (through 2016). Hazard ratios (HR) for incident CHD for each smoking group compared with never smokers were estimated with adjusted Cox proportional hazard regression models. At baseline, there were 548 (12.4%) current, 782 (17.6%) former, and 3102 (70%) never smokers. During follow‐up (median, 13.8 years), 254 participants developed CHD. After risk factor adjustment, CHD risk was significantly higher in current smokers compared with never smokers (HR, 2.11; 95% CI, 1.39–3.18); the difference between former smokers and never smokers (HR, 1.37; 95% CI, 1.0–1.90) did not achieve statistical significance. Among current smokers, we did not observe a dose‐response effect for CHD risk. Additionally, in multivariable logistic regression models with a subset of our analytic cohort, current smokers had greater odds of coronary artery calcification score >0 compared with never smokers (odds ratio, 2.63; 95% CI, 1.88–3.68). Conclusions In a large prospective cohort of Black adults, current smoking was associated with a >2‐fold increased risk of CHD over a median follow‐up of greater than a decade.

Background Blacks are disproportionately affected by stroke compared with whites; however, less is known about the relationship between stroke and cigarette smoking in blacks. Therefore, we evaluated the relationship between cigarette smoking and all incident stroke in the JHS (Jackson Heart Study). Methods and Results JHS participants without a history of stroke (n=4410) were classified by self‐reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers at baseline (2000–2004). Current smokers were further classified by smoking intensity (number of cigarettes smoked per day [1–19 and ≥20]) and followed up for incident stroke (through 2015). Hazard ratios (HRs) for incident stroke for current and past smoking compared with never smoking were estimated with adjusted Cox proportional hazard regression models. After adjusting for cardiovascular risk factors, the risk for stroke in current smokers was significantly higher compared with never smokers (HR, 2.48; 95% CI, 1.60–3.83) but there was no significant difference between past smokers and never smokers (HR, 1.10; 95% CI, 0.74–1.64). There was a dose‐dependent increased risk of stroke with smoking intensity (HR, 2.28 [95% CI, 1.38–3.86] and HR, 2.78 [95% CI, 1.47–5.28] for current smokers smoking 1–19 and ≥20 cigarettes/day, respectively). Conclusions In a large cohort of blacks, current cigarette smoking was associated with a dose‐dependent higher risk of all stroke. In addition, past smokers did not have a significantly increased risk of all stroke compared with never smokers, which suggests that smoking cessation may have potential benefits in reducing the incidence of stroke in blacks.

Objective: Distortion product otoacoustic emissions (DPOAEs) are sensitive to early indices of cochlear pathology. Pathology to the cochlea is in part mediated by ischaemic related mechanisms. We propose that DPOAEs may provide an objective measure of cardiovascular risk. Design: Cross-sectional. Study sample: The relationships between stroke risk and DPOAEs of 1,107 individuals from the Jackson Heart Study (JHS), an all-African-American cohort, were assessed. Linear regression models were used for analysis among all participants and delimited to normal hearing, defined as either a pure-tone threshold average of 500, 1000, 2000, and 4000 Hz (PTA4) ≤ 25 dBHL or pure-tone thresholds for all individual tested frequencies for each ear (500, 1000, 2000, 4000, and 8000 Hz) ≤ 25 dBHL. Results: We observed a significant inverse relationship between DPOAE amplitudes and stroke risk scores in the pooled cohort and in the subgroups with normal hearing defined by pure tone thresholds. Participants in the high-risk group had significantly lower DPOAE amplitudes than those in the low stroke risk group. Conclusions: Our results indicate that auditory dysfunction as measured by DPOAEs are related to stroke risk. Further prospective studies are needed to determine if DPOAEs could be used as a predictive tool for cardiovascular disease.

OBJECTIVES/HYPOTHESIS To describe the prevalence of reported tinnitus and tinnitus handicap in the all-African American Jackson Heart Study (JHS) cohort, with assessment of the relationship to cardiometabolic risk and depression. STUDY DESIGN Prospective cohort study. METHODS Audiologic data were obtained from a sample of 1,314 participants of the JHS. Reported tinnitus was assessed dichotomously (yes/no) by interview and with the Tinnitus Handicap Inventory (THI). The statistical relationship of reported tinnitus and tinnitus handicap to various cardiometabolic risks (i.e., hypertension and waist circumference) and Center for Epidemiologic Studies Depression scale (CES-D) was assessed with logistic and gamma regression procedures. RESULTS Tinnitus was found to be a highly prevalent condition (29.5%), with an additionally high rate of individuals who report at least slight tinnitus handicap (35%). Hypertension (β = 1.344, 95% confidence interval [CI]: 1.015-1.780, P = .039) and waist circumference (β = 1.009, 95% CI: 1.001-1.018, P = .021) were found to have a statistically significant relationship with THI score, depending on the level of covariate adjustment. Depression, as measured by the CES-D, was found to have a statistically significant relationship with both reported tinnitus (odds ratio [OR]: 1.051, 95% CI: 1.030-1.072, P < .001) and THI score (β = 1.029, 95% CI: 1.013-1.047, P = .001), which persisted for all levels of covariate adjustment in statistical models. CONCLUSIONS Tinnitus was found to be highly prevalent in the JHS, and certain measures of cardiometabolic risk are weakly related to both reported tinnitus and level of tinnitus handicap. A consistent relationship between depression and tinnitus/level of tinnitus handicap was observed. LEVEL OF EVIDENCE 2b. Laryngoscope, 128:1668-1675, 2018.

Objectives/hypothesis To evaluate the relationships among measures of stroke risk and hearing in an African American cardiovascular study cohort. Study design Prospective cohort study. Methods The relationships between stroke risk profiles and hearing of 1,107 individuals from a cohort of African Americans were assessed. Several different hearing pure-tone averages (PTAs) were constructed representing different frequency regions of hearing, namely PTA low, PTA mid, and PTA high. Stroke risk profiles were calculated using validated 10-year cardiovascular disease risk scores. Gamma regression analyses were performed for each PTA given as a continuous variable with change in stroke risk score. Logistic regression analyses, presented as odds ratios, were performed with hearing loss defined as any PTA >25 dB hearing level. Stratification models were analyzed for age quarterlies and among sex. Results Single unit increases of stroke risk percentage were found to be predictive of increases in all PTA threshold levels in gamma regression analyses for the overall pooled sample. The relationship was influenced by age, where fewer significant relationships were observed at higher ages. When analyzed with respect to stroke risk categories, using low risk as the reference group, there was found to be a significant association between stroke risk and hearing loss in the medium- and high-risk groups, with a stronger relationship in the high-risk group for all PTA threshold levels. Conclusions This study provides evidence that stroke risk has a positive predictive relationship with hearing pure-tone threshold. Level of evidence 2b. Laryngoscope, 128:1438-1444, 2018.

The availability of internet and/or mobile phone technology (IMT) provides an opportunity to explore more practical approaches to collect and disseminate information related to diabetes prevention and control in cohort studies. However, the extent of use of IMT in cohort studies of high-risk populations is unclear. In the Jackson Heart Study (JHS), a community-based cohort study of cardiovascular disease among African Americans with an increased prevalence of diabetes, we evaluated the prevalence and demographic correlates of IMT use. As part of annual follow-up telephone interviews of JHS participants in 2017-2018, we conducted a survey on IMT use and examined prevalence and demographic correlates of IMT use. Of 3,810 JHS participants in annual follow-up interviews, 2,564 (67.3%) completed the IMT use survey, of whom 2,262 (88.2%) reported IMT use. Compared to non-users, IMT users were more likely to be men (37% vs. 26%), younger (mean age 70 vs. 81years), and to have attained high school or more years of education (89% vs. 57%) and middle-affluent income status (91% vs.78%) (Table 1). For a majority of JHS participants, it may be feasible to use IMT to conduct intensive interviews and pilot diabetes-related communications. For participants with more limited use of IMT, standard methods will continue to be needed and novel methods developed to capture and disseminate information on diabetes prevention and control. Disclosure P.R. Anugu: None. K.A. Valle: None. K. Winters: None. A. Correa: None. Funding Jackson State University (HHSN268201800013I); Tougaloo College (HHSN268201800014I); Mississippi State Department of Health (HHSN268201800015I); University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I, HHSN268201800012I); National Heart, Lung, and Blood Institute; National Institute for Minority Health and Health Disparities

Objectives/hypothesis The objective of this study was to determine the audiological profile of an African American cohort, identify related factors, and compare them to other datasets. Study design Cross-sectional, longitudinal cohort study. Methods The Jackson Heart Study (JHS) is a longitudinal cohort study of 5,306 African Americans living in the metropolitan Jackson, Mississippi area, with a focus on cardiometabolic health. The JHS Hearing Study (n = 1,314) was implemented to measure the prevalence of hearing, tinnitus, and balance outcomes and relationship to predictor variables. Here we present prevalence and covariate relationships in comparison to the Epidemiology of Hearing Loss Study and the National Health and Nutrition Examination Survey. Results The prevalence of self-reported hearing difficulty was 38.1% (n = 500). The prevalence of hearing loss based on audiometric pure tone threshold average (0.5, 1.0, 2.0, 4.0 kHz) of the better ear was 19.8% (n = 260) and for the worse ear 29.8% (n = 392). The prevalence of tinnitus was 29.5% (n = 388) and balance dysfunction 24.1% (n = 317). Relationships of hearing loss to demographic, cardiometabolic, and audiologic variables are presented. Conclusions These results demonstrate that hearing loss, tinnitus, and balance dysfunction are common issues affecting adult African Americans, and that hearing loss is related to numerous modifiable and nonmodifiable risk factors. Furthermore, our findings are consistent with lower prevalence of hearing loss in African Americans compared to the non-African American populations. However, despite the lower audiometric evidence of hearing loss, nearly 40% of participants reported hearing difficulty. Level of evidence 2b Laryngoscope, 129:2391-2397, 2019.

Objectives There is limited research in population-based studies on auditory processing. The purpose of this work is to determine the prevalence of auditory processing impairment in the Jackson Heart Study cohort and to identify potential relationships with cardiometabolic risk factors. Study design Cross-sectional study. Setting Jackson Heart Study in Jackson, Mississippi. Subjects Participants of an all-African American cardiovascular study cohort (n = 1314). Methods The Quick Speech-in-Noise and Dichotic Digits, Double Pairs tests were used to assess auditory processing. Logistic regression and multinomial logistic regression models were used to examine how participants' cardiometabolic risk factors and audiologic characteristics were associated with speech perception in noise and binaural integration. Results Quick Speech-in-Noise and Dichotic Digits, Double Pairs testing showed a prevalence of auditory processing impairment in 69% and 71% of the cohort, respectively, which was significantly related to age, hearing thresholds, sex, and education level. With covariate adjustment in statistical models for age, sex, pure tone average, and education level, waist circumference, systolic blood pressure, and hypertension were statistically predictive of auditory processing impairment ( P Conclusion The results suggest a high prevalence of auditory processing deficits in the Jackson Heart Study cohort. In addition, cardiometabolic and audiologic factors show a statistically significant independent relationship with auditory impairment measures.

To describe the prevalence of reported tinnitus and tinnitus handicap in the all-African American Jackson Heart Study (JHS) cohort, with assessment of the relationship to cardiometabolic risk and depression.Prospective cohort study.Audiologic data were obtained from a sample of 1,314 participants of the JHS. Reported tinnitus was assessed dichotomously (yes/no) by interview and with the Tinnitus Handicap Inventory (THI). The statistical relationship of reported tinnitus and tinnitus handicap to various cardiometabolic risks (i.e., hypertension and waist circumference) and Center for Epidemiologic Studies Depression scale (CES-D) was assessed with logistic and gamma regression procedures.Tinnitus was found to be a highly prevalent condition (29.5%), with an additionally high rate of individuals who report at least slight tinnitus handicap (35%). Hypertension (β = 1.344, 95% confidence interval [CI]: 1.015-1.780, P = .039) and waist circumference (β = 1.009, 95% CI: 1.001-1.018, P = .021) were found to have a statistically significant relationship with THI score, depending on the level of covariate adjustment. Depression, as measured by the CES-D, was found to have a statistically significant relationship with both reported tinnitus (odds ratio [OR]: 1.051, 95% CI: 1.030-1.072, P.001) and THI score (β = 1.029, 95% CI: 1.013-1.047, P = .001), which persisted for all levels of covariate adjustment in statistical models.Tinnitus was found to be highly prevalent in the JHS, and certain measures of cardiometabolic risk are weakly related to both reported tinnitus and level of tinnitus handicap. A consistent relationship between depression and tinnitus/level of tinnitus handicap was observed.2b. Laryngoscope, 128:1668-1675, 2018.