Hearing Loss Among First Responders: Risks and Prevalence
This study delves into the association between noise exposure and hearing loss among different first responder occupations, focusing on the use of firearms and protective measures. Initial hypotheses and demographic results of law enforcement officers, firefighters, and other protective service workers are analyzed using CDC NHIS survey data from 2007 and 2014. The prevalence of hearing loss, tinnitus, and potential confounders like diabetes and kidney disease are explored to shed light on the impact of occupational hazards on hearing health in high-risk professions.
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Noise Exposure, First Responders and Hearing Loss Miranda Guilbo April 24th, 2018
Background Hearing Loss Presbycusis Noise induced: damaged to ear hair cells Other causes Trauma, birth defects, ototoxic chemicals, diabetes, kidney disease Tinnitus may be preliminary or co- symptom https://thehearinginstitute.org/hidden-hearing-loss-effect/
Background (Cont.) BLS estimates 657,690 Police Officers, 327,300 Firefighters in 2016 Due to variance and unpredictability in work, first responders may be at higher risk NIOSH HHE Occupational noise sources: firearms, sirens, machinery, explosions, fires, crowds Firearms produce impulse sound 140-160 dB OSHA PEL: 90 dB 8hr TWA; 140 dB for impulse noise
Specific Aims In different first responder occupations, determine level of association between hearing loss and noise exposures at work noise exposure outside of work firearms use Determine prevalence on hearing protection use and it s effectiveness to protecting from hearing loss
Initial Hypothesis Due to increased use of firearms in and outside of the workplace, law enforcement officers will show a higher prevalence of hearing loss, compared to other first responder occupations and all other occupations.
Methods CDC NHIS 2007 and 2014 Survey data 3 study populations: Law Enforcement Officer, Firefighters, Other Protective Services Reference: All other occupations Main Outcomes: Hearing Loss, Tinnitus Confounders: Diabetes, Kidney Disease, Smoking, Age Other Covariates: Veteran Status, Working Status
Results: Demographics Law Enforcement Workers Other Protective Services All Other Occupations Firefighters Sample % 0.69% LEO 0.15% FF 0.90% OPS 98.26% Mean Age 44.81 47.66 44.01 48.45 Race White (78.48%) White (90.81%) White (68.63%) White (80.67%) Sex Male (76.26%) Male (97.01%) Male (68.17%) Female (54.87%) Veteran 16.39% 20.00% 13.91% 5.78% US Citizen 99.87% 100% 96% 92.55% Annual Income >$75,000 (15.53%) >$75,000 (17.78%) <$15,000 (18.00%) <$15,000 (12.47%)
Results: Continued Law Other Protective Services All Other Occupations Enforcement Workers Firefighters Hearing Less than Good 14.81% 26.33% 16.84% 17.23% Tinnitus 12.60% 17.71% 10.68% 11.00% Exposed to Noise at Work Exposed to Noise Outside of Work 63.09% 43.58% 71.67% 76.47% 42.75% 61.62% 32.46% 26.64% Firearms Use 87.38% 70.38% 50.33% 32.07%
Results: Confounders For hearing worse in one ear , firefighters and other occupations showed equal hearing loss in both ears. Law enforcement showed higher hearing loss in left versus right ear. Self Reported Cause of Hearing Loss Law Enforcement Firefighters 0.68%** 4.03% 3.76%** 5.41% 11.18%* 3.03% 15.39% Hearing Loss Cause Birth Illness or Trauma Impulse Noise Constant Noise Noise of Unknown Source Ageing Other/Unknown Other Protective Services 0.45%** 4.17% 4.65% 4.67% All Other Occupations 1.05% 3.32% 3.64% 3.85% -- 0.86%** 0.72%** 3.78% 2.79% 1.73%* 2.71%* 0.90%** 1.52%* 0.32%* 3.34% 3.87% 2.79%
Results: Hearing Protection Use When asked about hearing protection use during firearms use, 52% of FF with hearing loss used HP less than half the time. LE (86% and 95%) and OPS (74% and 87%) had similar rates of with hearing protection use more than half the time in both hearing loss outcomes. When asked about hearing protection use at work 90% of FF with hearing loss wore HP less than half the time. In LE and OPS, majority reported wearing HP less than half the time, regardless of hearing loss. 82% and 88% for LE; 88% and 93% for OPS. 89% of AOO with hearing loss wore HP more than half the time.
Results: Noise Exposures Outside of Work Exposure to Very Loud Noise Sources Outside of Work in Firefighters Hearing Less than Good Noise Source Total Yes Lawn Mower 43 (77.31%) 18 (38.58%) Farm Machinery 2 (0.02%) Power Tools 38 (62.10%) 16 (44.14%) 22 (55.86%) Household Appliances 23 (36.03%) 14 (66.58%) Vehicles 33 (64.62%) Rock Concerts 17 (29.44%) CD/MP3 Player 7 (38.51%) Other Music 3 (25.69%) Sporting Event 2 (2.22%) Firearms 9 (44.94%) Videogames 1 (15.27%) Other 7 (33.34%) Chi Squared P Value No 25 (61.32%) 0.2308 0.0462 <0.0001 0.4463 0.0811 - 9 (33.42%) 12 (71.15%) 12 (69.87%) 6 (90.41%) 3 (100%) 2 (100%) 6 (74.12%) 1 (100%) 5 (79.25%) 6 (28.85%) 5 (30.13%) 1 (9.59%) - - 3 (25.88%) - 2 (20.75%) - - - -
Results: Multivariable Analysis Association Between Occupation and Hearing Related Issues in Protective Services Hearing Loss Unadjusted Odds Ratio 1.720 (1.069, 2.769) 0.835 (0.602, 1.158) 0.972 (0.761,1.240) Tinnitus 1.742 (1.016, 2.986) 1.166 (0.813, 1.674) 0.967 (0.703, 1.332) P-value Adjusted Odds Ratio 2.055 (1.255, 3.363) 1.090 (0.772, 1.540) 1.166 (0.901, 1.540) P-value Firefighters 0.0254 0.0042 Law Enforcement 0.2790 0.6244 Other Protective Services 0.8175 0.2416 1.822 Firefighters 0.0437 0.0306 (1.058, 3.138) 1.294 (0.896, 1.869) 1.027 (0.743, 1.419) Law Enforcement 0.4035 0.1697 Other Protective Services 0.8391 0.8730
Discussion After adjusting for possible confounders, firefighters were at increased odds for both hearing loss and tinnitus. No significant risk for law enforcement or other protective services Increased odds firefighters possibly due to: Increased noise exposures outside of work Poor use of hearing protection Lack of understanding on hazard of noise exposure
Limitations Cross-Sectional Data Hearing loss is self reported No audiometry measurements Adjusted for age Exposure variables are self reported Noise exposure source, cause of hearing loss Missing data and Small Cell Size Veteran status Sex Citizenship Chemical Exposure
Implications Firefighters should be in workplace hearing conservation programs Education on noise hazards and hearing protection use in and outside of work Encourage use of hearing protection with communication capabilities Engineer control for siren https://www.firecom.com/cutting-out-the-noise/
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