Focus Area 28: Vision and Hearing Richard J. Klein National Center for Health Statistics Progress Review October 21, 20

1. Focus Area 28:Vision and Hearing Richard J. KleinNational Center for Health StatisticsProgress ReviewOctober 21, 2008

2. Vision and Hearing 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.

3. Highlighted Objectives Vision 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 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 Target met Improving Little or no change* Getting worse Baseline only Note: *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

4. Visual Impairment Among Children, 2007 Decrease Desired 2010 Target: 18 Rate per 1,000 children Total American Indian * 2010 Target Asian * Black White Hispanic Female Male Poor Near poor Middle/High income 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. Obj. 28-4

5. Vision Screening for Preschool Children, 2002 Increase Desired Total American Indian * 2010 Target: 52 Asian Black White Hispanic Female Male Poor Near poor Middle/High income With disability Without disability 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. Obj. 28-2

6. Dilated Eye Examination Among Adults, 2002 Increase Desired Total American Indian Asian Black 2010 Target: 58 White Hispanic Female Male Less than high school High school graduate At least some college Without diabetes 2010 Target: 76 With diabetes* 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. Obj. 28-1

7. Occupational Eye Injuries Resulting in Lost Work Days Decrease Desired Number of injuries per 10,000 workers, 2006 Number of injuries per 10,000 workers 2010 Target: 3.4 Total Female Male 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

8. Use of Protective Eyewear at Home Always or Most of the Time, 2002 Increase Desired Children 6-17 yrs Total Female Male 2010 Target: 20 Poor Near poor Middle/high income Adults 18 yrs + Total Female Male 2010 Target: 37 Less than high school High school graduate At least some college 0 10 20 30 40 50 60 Percent 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. Obj. 28-9a,b

9. Office Visits for Otitis Media Age-adjusted percent Decrease Desired 1997 2006 Visits per 1,000 children Total 2010 Target 2010 Target: 294 Black White Female Male Under 3 years 3-5 years 6-17 years 600 800 1200 0 200 400 1000 1400 Visits per 1,000 children 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

10. Hearing Examination in the Past 5 years Among Adults, 2003-04 Increase Desired Adults 20- 69 yrs Total 2010 Target: 35 Female Male 20-39 years 40-59 years 60-69 years Adults 70 yrs + Total 2010 Target: 41 Female Male 70-79 years 80+ years 0 10 20 30 40 50 60 Percent 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. Obj. 28-14a,b

11. Use of Hearing Aids by Adults with Hearing Loss Rate per 1,000 population Increase Desired Adults 70+ years Adults 20-69 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

12. Noise-Induced Hearing Loss Among Adults Decrease Desired Rate per 1,000 population 1999-02 2003-04 2010 Target: 88.1 Total White Black Mexican American Female Male 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. Obj. 28-18

13. 1999-02 Use of Ear Protection Devices Among Adults Exposed to Loud Noises Increase desired 2003-04 Rate per 1,000 population 700 2010 Target: 514.5 600 500 400 300 200 100 0 Total Female Male At work Outside work Firearms Other loud noises Source of exposure to loud noises 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

14. Vision and Hearing Objectives Target met Improving Little or no change* VisionObjectives HearingObjectives 28-11a-c. Newborn hearing screening, hearing evaluation and intervention services 28-12. Otitis media 28-13a-d. Use of hearing aid, new 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 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 Getting worse Baseline only No data 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.

15. Summary • 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.

16. 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

17. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm