ABS 090: The Productivity Costs Associated with Hearing Impairment: A Systematic Review

Matthew Nuzzolo ¹ ² ³ , Coralei Neighbors ¹ ² , Ethan D. Borre ² ³ ,Connor Pratson ¹ ⁴ , Anna Jilla ¹ , Kamaria Kaalund ¹ , Dana Younis ¹ , Gloria Zhang ¹ , Osondu Ogbuoji ⁴ ⁵ , Gillian D. Sanders-Schmidler ¹ ² ³ ⁶

¹ Duke University
² Department of Population Health Sciences, Duke University School of Medicine
³ Duke-Margolis Institute for Health Policy, Duke University
⁴ Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine
⁵ Center for Policy Impact in Global Health, Duke Global Health Institute
⁶ Duke Clinical Research Institute, Duke University School of Medicine

Van Wickle (2025) Volume 1, ABS 090

Introduction: Hearing loss significantly impacts patients' quality of life and overall health, but its effects on productivity costs—including economic productivity as well as workforce and educational participation—are substantial and quantifiable. This study aimed to systematically review and synthesize evidence on productivity costs associated with hearing loss across the lifespan of people living in high-, middle-, and low-income countries.

Methods: Comprehensive database searches were conducted in October 2020 and October 2023. Literature management and review were performed using DistillerSR. Abstracts and full-text articles were screened independently by at least two investigators, with a third reviewer adjudicating any discrepancies. Inclusion criteria required studies to be original quantitative investigations, report indirect economic outcomes, and address language or cognitive outcomes that were directly tied to educational attainment. Only English-language studies meeting these criteria were included. Data were systematically extracted, and quality indicators were assigned to included studies to ensure methodological rigor.

Results: Hearing loss was found to be associated with economic productivity loss as well as inhibition on education attainment and workforce participation. The evidence demonstrates that hearing loss imposes substantial indirect productivity costs across the lifespan, with the burden disproportionately affecting those living in low- and middle-income countries.

Discussion: Early detection, access to assistive technologies, and inclusive educational and workplace policies significantly mitigate these costs. Policymakers should prioritize interventions targeting hearing loss to reduce its economic impact as well as enhance workforce and educational outcomes globally. Future research should address gaps in longitudinal data and evaluate the cost-effectiveness of scalable interventions in diverse socioeconomic settings.