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This cohort study was performed in 293,991 Korean adults free of HL who underwent a comprehensive screening examination and were followed for up to 8.8\u00a0years. HL was defined as a pure-tone average of thresholds at 0.5, 1.0, and 2.0\u00a0kHz\u2009\u2265\u200925\u00a0dB in both ears. During a median follow-up of 4.9\u00a0years, 2286 participants developed new-onset bilateral HL. Self-reported smoking status was associated with an increased risk of new-onset bilateral HL. Multivariable-adjusted HRs (95% CIs) for incident HL comparing former smokers and current smokers to never-smokers were 1.14 (1.004\u20131.30) and 1.40 (1.21\u20131.61), respectively. Number of cigarettes, pack-years, and urinary cotinine levels were consistently associated with incident HL. These associations were similarly observed when introducing changes in smoking status, urinary cotinine, and other confounders during follow-up as time-varying covariates. In this large cohort of young and middle-aged men and women, smoking status based on both self-report and urinary cotinine level were independently associated with an increased incidence of bilateral HL. Our findings indicate smoking is an independent risk factor for HL.<\/jats:p>","DOI":"10.1038\/s41598-021-87531-1","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T10:05:44Z","timestamp":1618394744000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Self-reported and cotinine-verified smoking and increased risk of incident hearing loss"],"prefix":"10.1038","volume":"11","author":[{"given":"Woncheol","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoosoo","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hocheol","family":"Shin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seungho","family":"Ryu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"87531_CR1","unstructured":"Deafness and hearing loss, https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/deafness-and-hearing-loss"},{"key":"87531_CR2","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1001\/jama.279.21.1715","volume":"279","author":"KJ Cruickshanks","year":"1998","unstructured":"Cruickshanks, K. 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