# Presentation: 748122

## Focus Area 28:Vision and Hearing  Richard J. KleinNational Center for Health Statistics Progress ReviewOctober 21, 2008

## Vision 
About 21 million U.S. adults are visually impaired.
An average lifetime cost for a person with visual impairment - $601,000 (in 2003 dollars)
Hearing 
About 36 million (17%) American adults have some degree of hearing loss. 
Lifetime cost per person with prelingual severe to profound hearing loss exceeds $1 million. 
Prevention 
Early diagnosis, treatment, and use of protective devices can prevent vision and hearing loss.

**About 21 million U.S. adults are visually impaired.**
**An average lifetime cost for a person with visual impairment - $601,000 (in 2003 dollars)**
_***Hearing***_*** ***
**About 36 million (17%) American adults have some degree of hearing loss.**
**Lifetime cost per person with prelingual severe to profound hearing loss exceeds $1 million.**
_***Prevention ***_
**Early diagnosis, treatment, and use of protective devices can prevent vision and hearing loss.**

**Vision and Hearing**

**Notes:**
Annual economic and social costs of visual impairment - $67 billion 

Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment — United States, 2003. MMWR Morb Mortal Wkly Rep. 2004 Jan 30;53(3):57-9 

Pleis JR, Lethbridge-Зejku M. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(235). 2007. 
Overall, 17% of adults 18 years of age and over experienced some hearing difficulty without a hearing aid (defined as ‘‘a little trouble,’’ ‘‘a lot of trouble,’’ or ‘‘deaf’’). 

## Highlighted Objectives

**28-1.   Dilated eye examinations among adults **
**28-2.   Vision screening for children**
**28-4.   Visual impairment in children and adolescents**
**28-8a. Occupational eye injuries**
**28-9.   Protective eyewear use**

**Highlighted Objectives**

**Hearing**

**28-12.       Otitis media in children and adolescents**
**28-13a, c.  Use of hearing aids by adults with hearing loss**
**28-14a, b.  Hearing examinations among adults in last 5 years**
**28-16a.      Use of ear protection devices among adults**
**28-17.        Noise induced hearing loss among adolescents **
**28-18.        Noise induced hearing loss among adults **

- Improving

- Getting worse

- Little or no change*

- Baseline only

- Target met

- Note: *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

** **

** **

** **

** **

##  Visual Impairment Among Children, 2007

**Hispanic**

** ****Visual Impairment Among Children, 2007**

**Total**

**White**

**American Indian**

**Asian**

**Black                    **

**Near poor**

**Poor**

**Middle/High income**

**Obj. 28-4**

**   ****Decrease Desired**

**  ****Rate per 1,000 children**

- Note: I = 95% confidence interval. *Data are unreliable.** **Data are for children ages 17 years and under who have trouble seeing even when wearing glasses or contact lenses. The visual impairment data include blindness. American Indian include Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group.
- Source: National Health Interview Survey (NHIS), CDC, NCHS.

**2010 Target: 18**

**Male**

**Female**

*****

*****

- 2010 Target

- Rate per 1,000 children

**Notes:**
(Describe slide)  

##  Vision Screening for Preschool Children, 2002

**Hispanic**

** ****Vision Screening for Preschool Children, 2002**

**Total**

**White**

**American Indian**

**Asian**

**Black                    **

**Near poor**

**Poor**

**Middle/High income**

**Obj. 28-2**

**  ****Percent**

- Note: I = 95% confidence interval. *Data are unreliable. Data are for children ages 5 years and under who have ever had their vision tested. American Indian include Alaska Native.** **The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group.
- Source: National Health Interview Survey (NHIS), CDC, NCHS.

**2010 Target: 52**

**Male**

**Female**

*****

**With disability**

**Without disability**

**Notes:**
(Describe slide)  

## Dilated Eye Examination Among Adults, 2002

**Hispanic**

**Dilated Eye Examination Among Adults, 2002**

**Total**

**White**

**American Indian**

**Asian**

**Black                    **

**High school graduate**

**Less than high school**

**At least some college**

**Obj. 28-1**

**  ****Percent**

- Note: I = 95% confidence interval. *Data for adults with diabetes are for those who had a dilated eye examination in the past year.** **
- Except for education levels, data are for adults 18 years and over who had a dilated eye exam within the past two years; education-level data are for adults 25 years and over. Data are age adjusted to the 2000 standard population. American Indian include Alaska Native.** **The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. Source: National Health Interview Survey (NHIS), CDC, NCHS.

**2010 Target: 58**

**Male**

**Female**

**Without diabetes**

**With diabetes***

**2010 Target: 76**

**Notes:**
(Describe slide)  
. 

## Occupational Eye Injuries Resulting           in Lost Work Days

**Number of injuries per 10,000 workers**

**Occupational Eye Injuries Resulting           in Lost Work Days**

**Total**

**2010 Target: 3.4**

- Note: Data are for occupational eye injuries among private industry employees that required medical treatment beyond first aid and that resulted in one or more days away from work. Data are for full time workers aged 16 years and older. Full time work = 2,000 hours worked per calendar year. The BLS private industry classification excludes agricultural workers on farms with fewer than 11 employees, self-employed, private household workers, and city, state, and federal employees in public administration.
- Source: Survey of Occupational Injuries and Illnesses, Department of Labor, Bureau of Labor Statistics.

**Obj. 28-8a**

**Total**

**Female**

**Male**

- Number of injuries per 10,000 workers, 2006

**2010 Target: 3.4**

## Use of Protective Eyewear at Home 

**Percent**

**Total **

**Female  **

**Male**

**Poor**

**Near poor**

**Middle/high income**

**Total**

**Female  **

**Male**

**Less than high school**

**High school graduate **

**At least some college**

**Use of Protective Eyewear at Home **
**Always or Most of the Time, 2002**

_**Children 6-17 yrs **_

_**Adults 18 yrs +**_

**0**

**20**

**30**

**10**

**60**

**40**

**50**

**2010 Target: 37**

**2010 Target: 20**

**Obj. 28-9a,**** ****b**

- Note: I = 95% confidence interval.** **Data are for children 6 years and over who were involved in activities that can cause eye injury and who wore protective eyewear always or most of the time. Except for education levels, data are for adults 18 years and over; education-level data are for adults 25 years and over. Adult data are age adjusted to the 2000 standard population.
- Source: National Health Interview Survey (NHIS),** **CDC, NCHS.

## Office Visits for Otitis Media

**0**

**Visits per 1,000 children**

**1000**

**200**

**400**

**1400**

**1997**

**2006**

**Total**

**Male**

**Black**

**6-17 years**

**White**

**Female **

**Under 3 years**

**3-5 years**

- Age-adjusted percent

**Office Visits for Otitis Media**

- Note: I = 95% confidence interval. Data are for visits to ambulatory care facilities with a diagnosis of otitis media (ICD-9-CM codes 381.0-381.4, 382) among persons under age 18 years. The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded.** **
- Source: National Ambulatory Medical Care Survey (NAMCS)/National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

**Obj. 28-12**

**2010 Target: 294**

- 2010 Target

- Visits per 1,000 children

** ****Decrease Desired**

**600**

**800**

**1200**

## Hearing Examination in the Past 5 years 

**Percent**

**Total **

**Male  **

**Female**

**20-39 years**

**40-59 years**

**60-69 years**

**Total**

**Female  **

**Male**

**70-79 years **

**80**** ****+ years**

**Hearing Examination in the Past 5 years **
**Among Adults, 2003-04**

_**Adults 20- 69 yrs **_

_**Adults 70 yrs +**_

**0**

**20**

**30**

**10**

**60**

**40**

**50**

**2010 Target: 41**

**2010 Target: 35**

**Obj. 28-14a,**** ****b**

- Note: I = 95% confidence interval.** **Data are for adults aged 20 years and over who have had a hearing exam within the past 5 years. Except for age-specific estimates data for adults ages 20-69 years old are age adjusted to the 2000 standard population.**  **
- Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

## Use of Hearing Aids by Adults with   Hearing Loss

**Rate per 1,000 population**

**Use of Hearing Aids by Adults with   Hearing Loss**

**Adults 20-69 years**

**Adults 70+ years**

- Note: Data are preliminary. Data are for adults aged 20+ years with hearing impairments who have ever used a hearing aid or assistive listening devices or who have cochlear implants. For adults 20-69 years old data are age adjusted to the 2000 standard population. The Healthy People 2010 target for objective 28-13a and c will be determined at a later date.
- Source: National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS), CDC, NCHS.

**Obj. 28-13a,**** ****c**

**        ****Increase Desired**

## Noise-Induced Hearing Loss Among Adults 

**Obj. 28-18**

**White**

**Mexican**
**American**

**Total**

**Male**

**2010 Target: 88.1**

**1999-02**

**2003-04**

**Black**

**Female**

- Note: I = 95% confidence interval.** **Data are for adults 20 to 69 years who have an audiometric notch in both ears signifying the noise induced hearing loss. Data are age adjusted to the 2000 standard population.** **Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races.  For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

**Rate per 1,000 population**

## Use of Ear Protection Devices Among Adults Exposed to Loud Noises

** **

**Use of Ear Protection Devices Among Adults Exposed to Loud Noises**

**2010 Target: 514.5**

**   ****Increase desired**

- Note: I = 95% confidence interval.** **Data are for adults 20-69 years who report they have ever worn a hearing protective device when exposed to loud sounds or noises. Data are age adjusted to the 2000 standard population.
- Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

**Obj. 28-16a**

**Rate per 1,000 population**

**100**

**200**

**300**

**400**

**500**

**600**

**700**

**Total**

**Female**

**Male**

**At work**

**Outside work**

**Firearms**

**Other loud noises**

**Source of exposure to loud noises**

**2003-04**

**0**

## Vision and Hearing Objectives

**Vision***** *****Objectives**

- Getting worse

- Baseline only

- Note: *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.
- † Objective 28-15 was deleted at Midcourse Review due to lack of data.

**28-1. Dilated eye examinations **
**28-2. Vision screening for children**
**28-3. Visual impairment due to refractive errors**
**28-4. Visual impairment and blindness in children and adolescents**
**28-5. Visual impairment due to diabetic retinopathy**
**28-6. Visual impairment due to glaucoma**
**28-7. Visual impairment due to cataract**
**28-8a,**** ****b. Occupational eye injuries**
**28-9a,**** ****b. Use of protective eyewear**
**28-10a,**** ****b. Use of visual rehabilitation**

**28-11a-c. Newborn hearing screening, hearing evaluation and intervention services **
**28-12. Otitis media**
**28-13a-d. Use of ****hearing aid, n****ew cochlear implants or assistive listening devices **
**28-14a-**** ****c. Hearing examinations**
**28-15. Evaluation and treatment referrals****†**
**28-16a,**** ****b. Hearing protection**
**28-17. Noise-induced hearing loss among adolescents**
**28-18. Noise-induced hearing loss among adults**

**Hearing***** *****Objectives**

- No data

## Visual impairment among children is virtually unchanged. 
Use of eye care services and use of protective eyewear are low.
Occupational eye injuries are gradually declining with significant disparity between females and males.  
Visits for otitis media decreased and met the target for all groups. 
Use of hearing examination and hearing aids among adults remain low. 
Rates of noise-induced hearing loss among adults and adolescents have not significantly changed. 

**Use of eye care services and use of protective eyewear are low.**
**Occupational eye injuries are gradually declining with significant disparity between females and males.  **
**Visits for otitis media decreased and met the target for all groups. **
**Use of hearing examination and hearing aids among adults remain low. **
**Rates of noise-induced hearing loss among adults and adolescents have not significantly changed. **

**Summary**

## Acknowledgements

**Acknowledgements**

**Asel Ryskulova****	**
**CDC/National Center for Health Statistics**
**avr0@cdc.gov**
- Contributors:
- Rosemary Janiszewski, NIH, NEI
- Howard Hoffman, NIH, NIDCD
- Chia-Wen Ko, NIH, NIDCD
- Leda Gurley, CDC, NCHS
- Lesley Agress, CDC, NCHS
- Jean Williams, CDC, NCHS
- Deepthi Kandi, CDC, NCHS

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**can be found on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**