Carotid atherosclerotic burden and hearing function across auditory frequencies in a low-income rural Chinese population: a population-based cross-sectional study
8 affiliations
- 1Department of Otorhinolaryngology, Central Hospital, Tianjin University/Tianjin Third Central Hospital
- 2The Third Central Clinical College of Tianjin Medical University
- 3School of Clinical Medicine, Tsinghua Medicine, Tsinghua University
- 4Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, The Fifth Affiliated Hospital of Tianjin University of Traditional Chinese Medicine
- 5Laboratory of Epidemiology, Tianjin Neurological Institute
- 6Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City
- 7Department of Otolaryngology–Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University
- 8National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center
Abstract
Background: Hearing impairment and carotid atherosclerosis are common in aging populations and share vascular risk factors, but whether carotid atherosclerotic burden is independently associated with hearing across auditory frequencies is uncertain, particularly in disadvantaged rural Asian populations. We examined these associations in a low-income rural Chinese population.
Methods: In this population-based cross-sectional study, adults aged ≥45 years underwent pure-tone audiometry and carotid ultrasonography. The primary outcome was bilateral overall pure-tone average (PTA) at 0.5–4 kHz; low-, mid-, and high-frequency PTAs were secondary outcomes. Exposures were mean carotid intima-media thickness (cIMT), plaque presence, plaque number, and total plaque area (TPA). Linear and logistic regression models were sequentially adjusted for demographic, behavioral, and cardiometabolic factors. Additional analyses addressed nonlinear age effects, effect modification by age and sex, ipsilateral versus contralateral carotid–ear associations, and continuous plaque burden.
Results: Among 1,933 participants (mean age, 60.8 ± 9.2 years; 37.5% men), 54.7% had no plaque, 25.5% a single plaque, and 19.8% multiple plaques. Overall PTA rose from 29.5 dB HL without plaque to 30.6 and 33.0 dB HL with single and multiple plaques, and hearing-impairment prevalence from 52.7% to 60.2% and 65.3% (both P < 0.001). These gradients were largely attenuated after adjustment for age and sex and changed little with further adjustment. In the fully adjusted model, multiple plaques were not associated with overall PTA ( β = 0.70 dB; 95% CI, −0.67 to 2.06), and neither cIMT nor plaque presence was associated with overall or frequency-specific PTA. Findings were robust to nonlinear age modeling, with no effect modification by age or sex and no stronger ipsilateral carotid–ear association. Among plaque-positive participants, each 1-SD increase in log-transformed TPA was associated with a 0.88-dB higher mid-frequency PTA (95% CI, 0.11–1.64; P = 0.025), but not with overall, low-, or high-frequency PTA.
Conclusions: Carotid atherosclerotic burden and poorer hearing co-occurred strongly in unadjusted analyses, but their association was largely explained by age, suggesting that the two conditions predominantly represent parallel manifestations of aging rather than a strong independent macrovascular relationship. The exploratory association between greater TPA and poorer mid-frequency hearing requires prospective validation.
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BibTeX
@article{dan2026carotid,
title = {{Carotid atherosclerotic burden and hearing function across auditory frequencies in a low-income rural Chinese population: a population-based cross-sectional study}},
author = {Jingjing Dan and Dongqing Xu and Jian Wang and Qixue Zhang and Huijuan Li and Jinghua Wang and Xin Li and Dong Yang},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.2003854},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.2003854/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Carotid atherosclerotic burden and hearing function across auditory frequencies in a low-income rural Chinese population: a population-based cross-sectional study
AU - Jingjing Dan
AU - Dongqing Xu
AU - Jian Wang
AU - Qixue Zhang
AU - Huijuan Li
AU - Jinghua Wang
AU - Xin Li
AU - Dong Yang
PY - 2026
DA - 2026/11/09
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.2003854
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.2003854/full
AB - Background: Hearing impairment and carotid atherosclerosis are common in aging populations and share vascular risk factors, but whether carotid atherosclerotic burden is independently associated with hearing across auditory frequencies is uncertain, particularly in disadvantaged rural Asian populations. We examined these associations in a low-income rural Chinese population. Methods: In this population-based cross-sectional study, adults aged ≥45 years underwent pure-tone audiometry and carotid ultrasonography. The primary outcome was bilateral overall pure-tone average (PTA) at 0.5–4 kHz; low-, mid-, and high-frequency PTAs were secondary outcomes. Exposures were mean carotid intima-media thickness (cIMT), plaque presence, plaque number, and total plaque area (TPA). Linear and logistic regression models were sequentially adjusted for demographic, behavioral, and cardiometabolic factors. Additional analyses addressed nonlinear age effects, effect modification by age and sex, ipsilateral versus contralateral carotid–ear associations, and continuous plaque burden. Results: Among 1,933 participants (mean age, 60.8 ± 9.2 years; 37.5% men), 54.7% had no plaque, 25.5% a single plaque, and 19.8% multiple plaques. Overall PTA rose from 29.5 dB HL without plaque to 30.6 and 33.0 dB HL with single and multiple plaques, and hearing-impairment prevalence from 52.7% to 60.2% and 65.3% (both P < 0.001). These gradients were largely attenuated after adjustment for age and sex and changed little with further adjustment. In the fully adjusted model, multiple plaques were not associated with overall PTA ( β = 0.70 dB; 95% CI, −0.67 to 2.06), and neither cIMT nor plaque presence was associated with overall or frequency-specific PTA. Findings were robust to nonlinear age modeling, with no effect modification by age or sex and no stronger ipsilateral carotid–ear association. Among plaque-positive participants, each 1-SD increase in log-transformed TPA was associated with a 0.88-dB higher mid-frequency PTA (95% CI, 0.11–1.64; P = 0.025), but not with overall, low-, or high-frequency PTA. Conclusions: Carotid atherosclerotic burden and poorer hearing co-occurred strongly in unadjusted analyses, but their association was largely explained by age, suggesting that the two conditions predominantly represent parallel manifestations of aging rather than a strong independent macrovascular relationship. The exploratory association between greater TPA and poorer mid-frequency hearing requires prospective validation.
SN - 2297-055X
ER -