The 25-Year Incidence and Progression of Hearing Loss in the Framingham Offspring Study.

Importance: Hearing loss is an impactful chronic condition among aging adults; however, little is known about the incidence and natural history of hearing loss. Objective: To examine the 25-year cumulative incidence and progression of hearing loss and determine associated factors. Design, Setting, and Participants: This study was conducted in the Framingham Offspring Study cohort in Framingham, Massachusetts. Participants were included if they had data from examinations 6 (baseline: 1995 to 1998) and 10 (follow-up: 2019 to 2022). Incidence analyses included 436 participants at risk of hearing loss, which was defined as no baseline hearing loss. Analyses focused on progression of hearing loss included the 511 participants with audiometric data from both examinations. Data were analyzed from November 26, 2024, to August 15, 2025. Exposures: Possible risk factors included self-reported age, sex, education, noise exposure history, smoking and heavy drinking, and measured hypertension, stroke risk (Framingham Stroke Risk Profile [FSRP]), low-density lipoprotein, high-density lipoprotein, and total cholesterol, fasting blood glucose, systolic and diastolic blood pressure, and waist circumference. Main Outcomes and Measures: Hearing was defined by the worse-ear pure-tone average (PTA) of thresholds at frequencies 0.5, 1.0, 2.0, and 4.0 kHz. Hearing loss was defined as PTA more than 25 dB HL, and progression as annualized increase in PTA. We used age- and sex-adjusted logistic and linear regression models to determine factors associated with incidence and progression of hearing loss; models were stratified by sex or baseline age (ie, ≤50 or >50 years) when interactions were present. Results: The 511 participants had a mean (SD) age of 52.2 (7.2; range, 34.7-74.4) years and 212 were male (41.5%). The 25-year cumulative incidence (among 436 at-risk participants) was 56.2% (246 participants) and the mean (SD) hearing loss progression was 15.1 (11.6) dB. Factors associated with incident hearing loss included older age, lower education, and high noise exposure, and, among participants aged more than 50 years, hypertension and higher FSRP. Factors associated with hearing loss progression included older age, female sex, lower education, and among participants aged more than 50 years, hypertension and higher diastolic blood pressure. Conclusions and Relevance: In this cohort study, the 25-year incidence and progression of hearing loss was examined. Findings corroborate hearing loss as an important public health concern that may be at least partially preventable.