Familism, Family Cohesion, and Hearing Loss in U.S. Hispanic/Latino Adults

Within the World Health Organization's International Classification of Functioning, Disability and Health, audiometric hearing loss and perceived hearing handicap are related but distinct. Family relational processes may buffer how sensory loss translates into lived burden via support, communication norms, and coping. We tested whether familism or family cohesion moderated the association between hearing loss and perceived handicap among Hispanic/Latino adults.

Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos and the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 4889). Hearing loss was defined as better-ear four-frequency pure-tone average (PTA) >25 dB HL. Perceived hearing handicap was measured with the 10-item Hearing Handicap Inventory for Adults/Elderly-Screening version (HHIA/E-S). Adjusted associations of hearing loss with perceived handicap were estimated by multivariable regression. Moderation was tested with continuous interaction terms for familism and family cohesion.

Participants with hearing loss had higher adjusted mean HHIA/E-S scores than those without (6.30 versus 2.91; Geometric Mean Ratio = 2.16, 116% higher; p < .001), indicating roughly double the perceived handicap among those with hearing loss. Although PTA was strongly related to handicap, variability in HHIA/E-S across the range of PTA continuum indicated incomplete correspondence between measures. Across all levels of familism and family cohesion, hearing loss was associated with approximately a two-fold higher perceived handicap (Geometric Mean Ratios ≈ 1.9 to 2.5). No consistent pattern of moderation by familism or family cohesion was noted.

Audiometric hearing loss was strongly associated with greater perceived handicap, and the magnitude of this association was similar across all levels of familism and family cohesion. Consistent with the World Health Organization's International Classification of Functioning, Disability and Health framework, audiometric thresholds and perceived impact only partially aligned in this cohort, and this relationship was not meaningfully altered by familism or family cohesion. Together, these findings underscore that audiometric thresholds alone do not fully capture the lived impact of hearing loss, as reflected by substantial variability in perceived handicap at similar levels of PTA, and highlight the importance of integrating self-reported experience with clinical history and patient context when identifying need and planning care.