Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain

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Abstract
Aims: To determine the prevalence of self reported hearing difficulties and tinnitus in working aged people from the general population, and to estimate the risks from occupational exposure to noise and the number of attributable cases nationally. Methods: A questionnaire was mailed to 22 194 adults of working age selected at random from the age–sex registers of 34 British general practices (21 201 subjects) and from the central pay records of the British armed services (993 subjects). Information was collected on years of employment in a noisy job; and whether the respondent wore a hearing aid, had difficulty in hearing conversation, or had experienced persistent tinnitus over the past year. Associations of hearing difficulty and tinnitus with noise exposure were examined by logistic regression, with adjustment for age, sex, smoking habits, and frequent complaints of headaches, tiredness, or stress. The findings were expressed as prevalence ratios (PRs) with associated 95% confidence intervals (CIs). Attributable numbers were calculated from the relevant PRs and an estimate of the prevalence of occupational exposure to noise nationally. Results: Some 2% of subjects reported severe hearing difficulties (wearing a hearing aid or having great difficulty in both ears in hearing conversation in a quiet room). In men, the prevalence of this outcome rose steeply with age, from below 1% in those aged 16–24 years to 8% in those aged 55–64. The pattern was similar in women, but severe hearing loss was only about half as prevalent in the oldest age band. Tinnitus was far more common in subjects with hearing difficulties. In both sexes, after adjustment for age, the risk of severe hearing difficulty and persistent tinnitus rose with years spent in a noisy job. In men older than 35 years with 10 or more years of exposure, the PR for severe hearing difficulty was 3.8 (95% CI 2.4 to 6.2) and that for persistent tinnitus 2.6 (95% CI 2.0 to 3.4) in comparison with those who had never had a noisy job. Nationally, some 153 000 men and 26 000 women aged 35–64 years were estimated to have severe hearing difficulties attributable to noise at work. For persistent tinnitus the corresponding numbers were 266 000 and 84 000. Conclusions: Significant hearing difficulties and tinnitus are quite common in men from the older working age range. Both are strongly associated with years spent in a noisy occupation—a predominantly male exposure. The national burden of hearing difficulties attributable to noise at work is substantial.