Equality in Hearing Aid Access: A Systematic Review and Meta-analysis

ImportanceMost people with hearing impairment do not acquire hearing aids, but it is unknown what sociodemographic factors influence access. ObjectiveTo systematically review, synthesize and meta-analyze sociodemographic characteristics of people who do and do not acquire hearing aids after hearing loss diagnosis. Data sourcesWe pre-registered the study (PROSPERO: CRD42023428580), and searched MEDLINE, EMBASE, and Web of Science from inception to 27 October 2025. Search terms included hearing aids and cohort study terms. Study selectionWe included observational studies with participants aged [&ge;]18 years who had hearing loss confirmed through pure-tone audiometry, with any sociodemographic characteristics of those who do and do not access hearing aids. Data extraction and synthesisUsing the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, three authors independently extracted data, assessing study quality using the Newcastle-Ottawa Scale. We calculated ratios of people with hearing loss from each sociodemographic characteristic who acquired hearing aids. We used random effects meta-analyses. Main outcomes and measuresHearing aid acquisition. Results36 studies including 300,946 people met criteria. Men were more likely to acquire hearing aids than women (n, 287,964; RR, 1.09[1.02-1.17]; I2, 98.7%), White people more than other ethnic/racial groups (n, 274,860; RR, 1.26[1.07-1.55]; I2, 99.9%), >12 years vs. [&le;]12 years of education (n, 5,970; RR, 1.17[1.04, 1.32]; I2, 79.4%), and pension recipients more than non-recipients (n, 1,678; RR, 1.50 [1.08,2.09], I2, 87.4%). There were no differences in hearing aid acquisition by very low household income ([&ge;]US$45,000/year vs. <US$45,000/year; RR, 1.06[0.87-1.30]; I2, 0%), employment status (currently employed vs. not employed (RR, 0.58[0.34-1.00]; I2, 84.2%), relationship status (currently married/partnered vs. not; RR, 0.96[0.87-1.16]; I2, 70.0%), living alone vs. with others (RR, 0.82[0.57-1.18]; I2, 97.7%) or rural vs. urban areas (RR, 1.20[0.86-1.68]; I2, 94.4%). Conclusion and RelevanceUnderserved groups (women, minorities, those with less education and not receiving pensions) are less likely to get hearing aids, even after hearing testing. Meta-analyses had high heterogeneity, so findings are not generalizable. Some underserved people can access hearing aids, and it is important to further investigate the barriers and enablers. No studies controlled for hearing severity, so findings are limited by confounding by indication. Key PointsO_ST_ABSQuestionC_ST_ABSWhat groups of people with diagnosed hearing loss acquire hearing aids? Finding: Among 300,946 individuals with hearing loss (36 studies), men, those with >12 years of education, pension recipients, and White individuals were more likely to acquire hearing aids. We found no differences based on household income, employment status, relationship status, rural vs. urban areas, and living arrangement. MeaningAfter accessing hearing services, hearing aid acquisition is related to sex, ethnicity or race, education, and pension status, but no other sociodemographic indicators. Further research is needed about enablers and barriers to obtaining hearing aids for women and ethnic minorities.