Abstract
Background Hearing loss, a highly prevalent sensory impairment affecting older adults, is a risk factor for cognition decline. However, there were very limited studies on this association in low-resource countries. This study aimed to assess whether having hearing loss were associated with cognitive decline and engagement in leisure activities modified this association among Chinese elderly. Methods Using data from the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011-2014, 9,710 individuals aged 65 years old or above with self-reported measures of hearing status and global cognition, as measured by the Modified Mini Mental Examination (MMSE), were included in this study. Fixed-effects models were used to estimate whether leisure activity engagement moderated the association of self-perceived hearing loss with global cognitive change in the overall sample and by sex. Results People with self-reported hearing loss was associated with cognitive impairment, with an odds ratio of 2.48 [1.22, 5.06]. Sex difference on the association of hearing loss and cognitive impairment was not found. Self-reported hearing loss was associated with cognitive function decline with 8% [-1.22, -0.39] increase in risk compared with those with normal hearing. Frequent engagement in leisure activities moderated the association between hearing loss and cognition. Actively participating in leisure activities modified the relationship between hearing loss and cognitive decline in males, while leisure activity engagement did not modify any associations among females. Conclusion Hearing loss was associated with cognitive decline, and leisure activities engagement moderated the association among males rather than females.