Association of pain with self-reported hearing difficulty among adults aged 50 years or older in six prospective cohorts

Background Pain is highly prevalent in older adults and linked to hyperacusis, yet evidence on its relationship with self-reported hearing difficulty (HD) remains limited. The aim of this study was to investigate the associations of pain with incident HD. Methods Adults aged ≥50 from six nationally-representative aging cohorts were included: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the Mexican Health and Ageing Study (MHAS), the China Health and Retirement Longitudinal Study (CHARLS), and the Korean Longitudinal Study of Aging (KLoSA). Pain trajectories were derived from four consecutive biennial assessments of pain severity. Logistic regression was applied to examine cross-sectional associations between pain and HD. Cox proportional hazards models assessed longitudinal associations of pain with HD. Primary analyses adjusted for age, sex, education, marital status, smoking, alcohol consumption, hypertension, and diabetes; sensitivity analyses additionally included depressive symptoms as a covariate. Results Cross-sectional and longitudinal analyses included 130,521 participants (mean age 62.8 years; range 50-106) and 11,067 participants (mean age 60.9 years; range 50-87), respectively. Frequent pain was associated with higher odds of HD, with dose-response gradients for severity (P-trend<0.001). Five distinct pain trajectories were defined. Participants in the persistent moderate-severe pain trajectory group had the highest risk of HD (Pooled HR=1.62, 1.38-1.90), followed by the increasing group (Pooled HR=1.31, 1.07-1.59) and the fluctuating group (Pooled HR=1.25, 1.14-1.38), while decreasing pain trajectories showed no significant associations. The persistent no-mild pain group served as the reference group. In sensitivity analyses, Group-Based Trajectory Modeling (GBTM) further identified three distinct pain trajectories. Conclusion Pain status and dynamic trajectories significantly impact HD risk. Standardized pain management should be integrated into future HD prevention strategies.