{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:49:44Z","timestamp":1792788584403,"version":"4.5.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020578","name":"Department of Jobs, Tourism, Science and Innovation, Government of Western Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020578","id-type":"DOI","asserted-by":"publisher"}]},{"name":"City of Busselton"},{"name":"Private donations"},{"name":"The Western Australian Country Health Service"},{"name":"Pathwest"},{"name":"Abbott","id":[{"id":"https:\/\/ror.org\/0052svj16","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Stallargenes"},{"DOI":"10.13039\/100017647","name":"ResMed","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017647","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wesnes Cognition LTD"},{"DOI":"10.13039\/100011095","name":"BD Biosciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>With the ageing of the global population, disabling hearing loss is a major health concern. While age and sex are established determinants, the relation between general and environmental health factors and the progression of hearing loss remains incompletely understood, particularly in middle-aged adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used data from the\n                      <jats:italic>Busselton Healthy Ageing Study (BHAS)<\/jats:italic>\n                      , a population-based cohort in Western Australia. Adults aged 45\u201370 years at baseline (2010\u20132015) underwent audiometric testing and health assessments with a six-year follow-up. The better-ear four-frequency Pure Tone Averages for 0.5-4kHZ (4FPTA) and for high frequencies (4 &amp; 8 kHz) (HFPTA) were calculated. Hearing loss was classified according to WHO criteria. Demographic, ear-related, general health, and environmental factors were analysed and their association with change in hearing thresholds using linear mixed models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>3596 participants with reliable audiometry at baseline and follow-up were included (mean baseline age 57.9 years, 55% female). Over 6 years follow-up, the prevalence of mild-or-greater hearing loss increased from 14% to 26% (4FPTA) and from 53% to 71% (HFPTA). Thresholds worsened across all age categories, with greater deterioration in men and at higher frequencies. In univariate models, older age, male sex, higher BMI, smoking, tinnitus, chronic ear infection, noisy workplace exposure (particularly with inconsistent or absent hearing protection), hypertension and pre-diabetes were significantly associated with faster hearing decline after adjustments for age and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this longitudinal population-based study of middle-aged Western Australians we demonstrated that hearing thresholds significantly declined over a six-year period with greater deterioration in men and at higher frequencies. Findings suggest that hearing loss progression in midlife is shaped not only by age and sex, but also by broader metabolic and environmental health profiles. These outcomes highlight the need for future research to further clarify the complex interplay between metabolic health, environmental exposures, and hearing outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360651","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:27:03Z","timestamp":1792085223000},"page":"e0360651","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Change in hearing loss and its association with general health in a community-based longitudinal study of middle-aged individuals: The Busselton healthy ageing study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9126-9969","authenticated-orcid":true,"given":"Adriana L.","family":"Smit","sequence":"first","affiliation":[{"name":"Head & Neck Surgery, University Medical Center Utrecht","place":["Utrecht, Netherlands"],"department":["Department of Otorhinolaryngology"]},{"name":"UMC Utrecht Brain Center, University Medical Center Utrecht","place":["Utrecht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Eikelboom","sequence":"additional","affiliation":[{"name":"Centre for Ear Sciences, The University of Western Australia","place":["Nedlands, Australia"]},{"name":"University of Pretoria","place":["Pretoria, South Africa"],"department":["Department of Speech Language Pathology and Audiology"]},{"name":"Ear Science Institute Australia","place":["Subiaco, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinan","family":"Mao","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery, University Medical Center Utrecht","place":["Utrecht, Netherlands"],"department":["Department of Otorhinolaryngology"]},{"name":"UMC Utrecht Brain Center, University Medical Center Utrecht","place":["Utrecht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6704-4815","authenticated-orcid":true,"given":"Michael","family":"Hunter","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, University of Western Australia","place":["Perth, Australia"]},{"name":"Busselton Health Study Centre, Busselton Population Medical Research Institute","place":["Busselton, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus D.","family":"Atlas","sequence":"additional","affiliation":[{"name":"Centre for Ear Sciences, The University of Western Australia","place":["Nedlands, Australia"]},{"name":"Ear Science Institute Australia","place":["Subiaco, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-1636","authenticated-orcid":true,"given":"De Wet","family":"Swanepoel","sequence":"additional","affiliation":[{"name":"University of Pretoria","place":["Pretoria, South Africa"],"department":["Department of Speech Language Pathology and Audiology"]},{"name":"University of Colorado School of Medicine","place":["Aurora, Colorado, United States of America"],"department":["Department of Otolaryngology-Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Stegeman","sequence":"additional","affiliation":[{"name":"Head & Neck Surgery, University Medical Center Utrecht","place":["Utrecht, Netherlands"],"department":["Department of Otorhinolaryngology"]},{"name":"UMC Utrecht Brain Center, University Medical Center Utrecht","place":["Utrecht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"pone.0360651.ref001","first-page":"655","author":"WHO","year":"2018"},{"key":"pone.0360651.ref002","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the Lancet Commission","author":"G Livingston","year":"2020","journal-title":"The Lancet"},{"issue":"10278","key":"pone.0360651.ref003","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0140-6736(21)00516-X","article-title":"Hearing loss prevalence and years lived with disability, 1990-2019: Findings from the Global Burden of Disease Study 2019","volume":"397","author":"LM Haile","year":"2021","journal-title":"The Lancet"},{"issue":"4","key":"pone.0360651.ref004","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1002\/lary.28971","article-title":"Modeling hearing loss progression and asymmetry in the older old: A national population-based study","volume":"131","author":"RK Sharma","year":"2021","journal-title":"Laryngoscope"},{"issue":"1","key":"pone.0360651.ref005","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1001\/jamaoto.2016.2661","article-title":"Increases in the rate of age-related hearing loss in the older old","volume":"143","author":"K Wattamwar","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"9","key":"pone.0360651.ref006","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/gerona\/gls066","article-title":"Cognitive, health, and sociodemographic predictors of longitudinal decline in hearing acuity among older adults","volume":"67","author":"KM Kiely","year":"2012","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"3","key":"pone.0360651.ref007","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s10162-008-0123-1","article-title":"Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: A European population-based multicenter study","volume":"9","author":"E Fransen","year":"2008","journal-title":"J Assoc Res Otolaryngol"},{"issue":"14","key":"pone.0360651.ref008","first-page":"1522","article-title":"Prevalence of hearing loss and differences by demographic characteristics among US adults","volume":"168","author":"Y Agrawal","year":"2008","journal-title":"Arch Intern Med"},{"issue":"5","key":"pone.0360651.ref009","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/jgs.13401","article-title":"Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment","volume":"63","author":"KJ Cruickshanks","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"pone.0360651.ref010","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.heares.2009.10.008","article-title":"Education, occupation, noise exposure history and the 10-yr cumulative incidence of hearing impairment in older adults","volume":"264","author":"KJ Cruickshanks","year":"2010","journal-title":"Hear Res"},{"issue":"10","key":"pone.0360651.ref011","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1001\/archotol.129.10.1041","article-title":"The 5-year incidence and progression of hearing loss: The epidemiology of hearing loss study","volume":"129","author":"KJ Cruickshanks","year":"2003","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"6","key":"pone.0360651.ref012","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1093\/gerona\/glt172","article-title":"Predictors of hearing acuity: Cross-sectional and longitudinal analysis","volume":"69","author":"AM Linssen","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0360651.ref013","volume-title":"Associations between cardiovascular risk factors and audiometric hearing: Findings from the canadian longitudinal study on aging","author":"PT Mick","year":"2023"},{"issue":"5","key":"pone.0360651.ref014","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1159\/000492203","article-title":"Progression of hearing loss in the aging population: Repeated auditory measurements in the rotterdam study","volume":"23","author":"SC Rigters","year":"2018","journal-title":"Audiol Neurootol"},{"issue":"9","key":"pone.0360651.ref015","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/14992027.2020.1865581","article-title":"Prevalence and incidence of hearing impairment among adults: A 13-year follow-up study","volume":"60","author":"V Lohi","year":"2021","journal-title":"Int J Audiol"},{"issue":"3","key":"pone.0360651.ref016","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1093\/gerona\/glab153","article-title":"Longitudinal blood pressure patterns from mid- to late life and late-life hearing loss in the atherosclerosis risk in communities study","volume":"77","author":"J Ting","year":"2022","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0360651.ref017","doi-asserted-by":"crossref","unstructured":"Elm EV, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. 2007;1453\u20137.","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"pone.0360651.ref018","article-title":"2. Classification and diagnosis of diabetes: standards of medical care in diabetes\u20142019","volume":"42","author":"American Diabetes Association","year":"2019","journal-title":"Diabetes Care"},{"key":"pone.0360651.ref019","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1186\/1471-2458-13-936","article-title":"Rationale, design and methods for a community-based study of clustering and cumulative effects of chronic disease processes and their effects on ageing: The Busselton healthy ageing study","volume":"13","author":"A James","year":"2013","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0360651.ref020","doi-asserted-by":"crossref","first-page":"78","DOI":"10.3766\/jaaa.18.1.7","article-title":"Qualind: A method for assessing the accuracy of automated tests","volume":"18","author":"RH Margolis","year":"2007","journal-title":"J Am Acad Audiol"},{"issue":"1","key":"pone.0360651.ref021","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/14992027.2018.1518598","article-title":"The World Health Organization\u2019s hearing-impairment grading system: An evaluation for unaided communication in age-related hearing loss","volume":"58","author":"LE Humes","year":"2019","journal-title":"Int J Audiol"},{"issue":"19","key":"pone.0360651.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2017.11.005","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Pr","volume":"71","author":"PK Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"pone.0360651.ref023","author":"WHO Expert Committee","year":"1995"},{"key":"pone.0360651.ref024","author":"Australian Bureau of Statistics [Internet]","year":"2011"},{"issue":"25","key":"pone.0360651.ref025","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1056\/NEJMra1616601","article-title":"Hearing Loss in Adults","volume":"377","author":"LL Cunningham","year":"2017","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0360651.ref026","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.otot.2024.01.001","article-title":"Contemporary mechanics of conductive hearing loss","volume":"35","author":"A Remenschneider","year":"2024","journal-title":"Oper Tech Otolayngol Head Neck Surg"},{"issue":"8","key":"pone.0360651.ref027","article-title":"Relation between otitis media and sensorineural hearing loss: A systematic review","volume":"11","author":"HBE Elzinga","year":"2021","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0360651.ref028","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/AUD.0000000000000118","article-title":"Childhood otitis media: A cohort study with 30-year follow-up of hearing (the HUNT study)","volume":"36","author":"L Aarhus","year":"2015","journal-title":"Ear Hear"},{"issue":"4","key":"pone.0360651.ref029","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1055\/s-0039-1697643","article-title":"Epidemiology of diabetes and hearing loss","volume":"40","author":"R Baiduc","year":"2019","journal-title":"Semin Hear"},{"issue":"3","key":"pone.0360651.ref030","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jhealeco.2009.02.010","article-title":"Comparing subjective and objective measures of health: Evidence from hypertension for the income\/health gradient","volume":"28","author":"DW Johnston","year":"2009","journal-title":"J Health Econ"},{"issue":"11","key":"pone.0360651.ref031","doi-asserted-by":"crossref","first-page":"2958","DOI":"10.1016\/S0149-2918(03)80347-8","article-title":"Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: A longitudinal cohort study","volume":"25","author":"R Balkrishnan","year":"2003","journal-title":"Clin Ther"},{"issue":"11","key":"pone.0360651.ref032","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.2337\/dc16-1925","article-title":"Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: A meta-analysis","volume":"40","author":"K Khunti","year":"2017","journal-title":"Diabetes Care"},{"issue":"4","key":"pone.0360651.ref033","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4258\/hir.2018.24.4.263","article-title":"Automated audiometry: A review of the implementation and evaluation methods","volume":"24","author":"H Shojaeemend","year":"2018","journal-title":"Healthc Inform Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360651","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:27:10Z","timestamp":1792085230000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360651"}},"subtitle":[],"editor":[{"given":"Gauri","family":"Mankekar","sequence":"first","affiliation":[{"name":"LSU Health Shreveport","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360651","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}