Cadmium, obesity, and education, and the 10-year incidence of hearing impairment: The beaver dam offspring study

Dayna S. Dalton, Carla R. Schubert, Alex Pinto, Mary E. Fischer, Guan Hua Huang, Barbara E.K. Klein, Ronald Klein, James S. Pankow, Adam J. Paulsen, Michael Y. Tsai, Ted S. Tweed, Karen J. Cruickshanks

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives/Hypothesis: To determine the 10-year incidence of hearing impairment (HI) and associated risk factors in the Beaver Dam Offspring Study (BOSS; 2004–present), a large middle-aged cohort followed for 10 years. Study Design: Prospective cohort study. Methods: Hearing thresholds were measured at baseline (2005–2008) and 5- (2010–2013) and 10-year (2015–2017) follow-up examinations. HI was defined as a pure-tone average >25 dB HL in either ear. BOSS participants free of HI at baseline with at least one follow-up examination (N = 2,065) were included. Potential risk factors evaluated included cardiovascular measures, health history, lifestyle factors, inflammatory markers, vitamins D and B12, lead, and cadmium. Results: Participants were 21 to 79 years (mean age = 47.9 years) at baseline. The 10-year cumulative HI incidence was 17.4% (95% confidence interval [CI]: 15.7–19.2) and was twice as likely in men (24.4%, 95% CI: 21.5–27.7) than in women (12.2%, 95% CI: 10.3–14.3). In a multivariable adjusted model, age (hazard ratio [HR] = 1.48, 95% CI: 1.38–1.59, per 5 years), male sex (HR = 2.47, 95% CI: 1.91–3.18), less than a college education (HR = 1.35, 95% CI: 1.02–1.79), body mass index (HR = 1.03, 95% CI: 1.01–1.05, per kg/m2), and higher cadmium levels (HR = 1.42, 95% CI: 1.05–1.92, quintile 5 vs. quintiles 1–4) were associated with the 10-year cumulative incidence of HI. There was no association between high lead levels, vitamins D or B12, and 10-year incidence of HI. Conclusions: In addition to age and sex, obesity, education, and blood cadmium levels were associated with increased incidence of HI. These prospective results add to evidence that age-related HI is a multifactorial preventable disorder. Level of Evidence: 2b Laryngoscope, 130:1396–1401, 2020.

Original languageEnglish (US)
Pages (from-to)1396-1401
Number of pages6
Issue number6
StatePublished - Jun 1 2020

Bibliographical note

Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.


  • Sensorineural hearing loss
  • epidemiology
  • midlife
  • neurotoxins
  • risk factors


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