Introduction: Hearing disability is a condition that affects normal ear function, as much in adulthood as in the first years of life. According to the 2005 Census, 6.3% of the Colombian population has some type of disability, of which 17.4% have hearing limitations, including those with hearing devices. Elucidating the conditions of this population and identifying the factors related to hearing disability will permit the management of strategies from different sectors to mitigate the consequences associated with this limitation. Objective: To estimate the self-perception of hearing disability in Colombia and to determine the factors associated with this limitation. Materials and Methods: The present study is cross-sectional, based on the analysis of secondary information obtained from the Registry for Localization and Characterization of Persons with Disability (RLCPD) during the 2002-2008 period. Socio-demographic and healthcare variables were analyzed. Results: 13.6% (102,648/750,377) of the population reported hearing limitations even with the use of special hearing devices. 43.52% (44,041) of people over 3 years of age could neither read nor write. 29.39% (30,145) of people who reported this limitation are not affiliated to any sort of health insurance system. Factors found to be associated with hearing limitations were: socioeconomic stratus (OR: 1.33; CI 95% 1.25; 1.42), illiteracy (OR: 1.44; CI 95% 1.42; 1.46) and lack of affiliation to a health insurance system (OR: 1.03; CI 95% 1.01; 1.04). Conclusion: People registered with hearing disability live under vulnerable conditions; among them, most/the majority pertained to a segment of the population with low economic resources and had difficulty obtaining/accessing work, education and healthcare services.
Hearing disability, or profound neurosensory hypoacusia, or profound deafness, is a condition that affects inner ear function, as much in adulthood as in the first years of life. It can be acquired from, and the principal causes are, infections such as Rubella, Toxoplasmosis, or Meningitis (it can also present at birth due to genetic disorders); however, close to 30% of registered cases are from unknown causes [
Depending on the grade and type of hearing loss and the time in life in which it appears, the effects that it will have over language development and the wellbeing of the individual are different. It is estimated that one of every 1000 live births can present profound neurosensory deafness requiring auditory and language rehabilitation [
The frequency of deafness in Colombia has not been clearly established [
In any case, early identification of the hearing deficit, followed by an appropriate intervention, will reduce the impact of this disability in each age group, with respect to the ability to communicate and socialize.
The objective of our study is to estimate the self-perception of hearing disability in Colombia according to the information in the Register for the Localization and Characterization of Persons with Disability (RLCPD), and to identify the factors associated with this limitation, in order to highlight social, educational, and health services which could lead to the re-integration, control, and recovery of persons with auditory disability.
The present study is cross-sectional, based on analysis of secondary information from the RLCPD, carried out by the Administrative Department of National Statistics (DANE), which has been conducted since 2002 and in- cludes information up to 2008. This information allows the identification of the population with disability in all age groups, with the purpose of establishing plans and strategies to improve their situation [
The register covers the entire country; since the basic sources of information are the municipalities, however, there exist differences in the degree of registration within the various territories as it is dependent on the participation and will of the local governors and mayors [
The total number registered for 2002-2008 was 750,277 persons with any degree of auditory disability, of which 102,648 report having permanent hearing limitations even with the use of special hearing devices. In the case of duplicate registrations, the oldest case was discarded. Information was analyzed according to question #30 in the registry: “In your daily activities, do you present permanent difficulties with hearing, even with the use of special hearing devices”, since it allows identification of the population that perceives itself with some hearing disability which interferes with their daily activities, in spite of the use of devices to improve hearing.
A descriptive frequency analysis was carried out on the different variables analyzed in the questionnaire such as age, sex, family characteristics, home characteristics, education, work, origin of the disability, and health services, among others. Subsequently, a bivariate analysis was performed, and a statistical regression model was established where the dependent variable was self-perception of hearing disability and the independent variables were sex, age, ethnicity, family characteristics, health services, etc., and those variables which showed an association of p < 0.10 in the bivariate analysis, or which were considered important for analysis within the model. A p value of 0.05 was considered significant, with confidence intervals calculated at 95%. Statistical analysis was conducted with Stata 9.0.
Self-perception of hearing disability: According to the RLCPD, 13.6% of the persons registered with hearing disability reported hearing limitations even with the use of special hearing devices (102,648/750,377).
A slight predominance was observed in women 50.35% (51,681) over men 49.65% (50,967). Of the 32 depart- ments in the country, the majority of registrations were in Bogotá, with 20.96% (this city is considered a de- partment in the registry), followed by Valle del Cauca 8.79%, Nariño 8.41%, Antioquia 7.52%, Tolima 6.21%, and Cundinamarca 5.74%, with all other departments constituting 42.18%.
Analysis by age showed the following distribution: 0 to 19 years, 17.58% (18,044); 20 to 49, 21.86% (22,432); and 50 and older 60.56% (62,149). The majority belonged to socioeconomic stratus 1, 2, 3 or without stratus (98.86%). By ethnic group, 93.0% (94,225) consider themselves “Mestizos”, 3.71% (3755) of African descent, 2.96% (2995) as indigenous, 0.2% (202) “Raizals”, 0.1% (104) “Palenqueros”, and 0.03% (36) “Gypsies”/ “Roma”.
Category | n | % | |
---|---|---|---|
Condition of the household | Their own home | 52,065 | 53.06 |
Another person’s home, not paying | 23,629 | 24.08 | |
Renting or subletting | 20,839 | 21.24 | |
Other | 1589 | 1.62 | |
Principal activity in the last 6 months | Unable to work, without pension | 32,957 | 35.15 |
Housework | 20,831 | 22.21 | |
Employed | 11,997 | 12.79 | |
Other activity | 8451 | 9.01 | |
Studying | 6932 | 7.39 | |
Unable to work, with pension | 3794 | 4.05 | |
Self-sustainment | 3206 | 3.42 | |
Searching for employment | 3244 | 3.46 | |
Pensioned | 1592 | 1.70 | |
Receiving rent | 769 | 0.82 | |
Dependents | Yes | 15,802 | 16.57 |
No | 79,542 | 83.43 | |
Socioeconomic stratus | 04/05/2006 | 1166 | 1.14 |
1-2-3, no stratus | 101,176 | 98.86 | |
Healthcare affiliation | Yes | 72,065 | 70.88 |
No | 29,604 | 29.11 | |
Knows how to read and write (older than 3 years) | Yes | 57,158 | 56.48 |
No | 44,041 | 43.52 | |
Requires the permanent help of another person | Yes | 42,179 | 58.9 |
No | 60,447 | 41.1 |
hearing limitations even with the use of special hearing devices.
7.46% of persons registered with this limitation live alone; this percentage increased following/after 60 years of age. 16.57% are dependent on another person upon analyzing this variable it was observed that within the last 6 months only 31.49% of these persons were employed 58.90% of those registered particularly in extreme age groups (younger than 10 and older than 60 years), indicated the need for permanent help from another person, this person being a member of the household in 88.98% of cases. Moreover, with respect to education, 43.52% of persons older than 3 years can neither read nor write, and the principal reason for which people of school age are not in school is because of disability (36.04%). Information about/ according to level of education and age can be found in
Of the total number of persons with a self-perceived hearing limitation 37.36% (37,309) do not know the origin of their limitation; of those that do 62.64% (65,263) attribute it to general illness 42.24% (27,565), followed by complications in childbirth or pregnancy 17.67% (11,532), genetic mutations 14.19% (9258) and accidents 13.44% (8769), as seen in
Since the RLCPD examines in great depth the origins of work disability, accidents, and difficulties in obtain-
Maximum level of education | 3 to 5 | 6 to 10 | 11 to 15 | 16 to 20 | 21 to 25 | 26 and older | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | |
None | 1131 | 70.20 | 1694 | 33.54 | 1539 | 25.53 | 1514 | 31.87 | 1330 | 38.14 | 32,532 | 41.96 |
Preschool | 477 | 29.61 | 989 | 19.58 | 355 | 5.89 | 151 | 3.18 | 98 | 2.81 | 1508 | 1.94 |
Primary | 0 | 1.92 | 2346 | 46.45 | 3141 | 52.11 | 1549 | 32.61 | 986 | 28.28 | 34,889 | 45.00 |
Secondary | 0 | 0.00 | 19 | 0.38 | 986 | 16.36 | 1457 | 30.67 | 914 | 26.21 | 7179 | 9.26 |
University | 0 | 0.00 | 0 | 0.00 | 7 | 0.12 | 79 | 1.66 | 159 | 4.56 | 1429 | 1.84 |
Total | 1611 | 100 | 5051 | 100 | 6028 | 100 | 4750 | 100 | 3487 | 100 | 77,537 | 100 |
Their Disability is due to | Hearing limitations even with the use of special hearing devices | ||
---|---|---|---|
n | % | ||
General illness | 27,565 | 42.24 | |
Complications during pregnancy or childbirth | 11,532 | 17.67 | |
Genetic disorder | 9258 | 14.19 | |
Accident | 8769 | 13.44 | |
Other | 4356 | 6.67 | |
Occupational disease | 1591 | 2.44 | |
Difficulty in providing health services | 1155 | 1.77 | |
Use of psychoactive drugs | 401 | 0.61 | |
Natural disaster | 155 | 0.24 | |
Self-inflicted injury | 481 | 0.74 | |
Total | 65,263 | 100 |
ing of healthcare services, it is notable that those that attribute their hearing disability to workplace illness, 61.47% (943) indicated that this was due to physical conditions and workplace safety. Of the 8769 persons who attributed the origin of their disability to accidents, 58.47% (5118) attribute it to traffic accidents, and of the 1155 people that attribute the origin of their disability to slow or deficient medical attention, 59.66% attribute it to slow or deficient medical attention.
29.11% (29,604) of persons who reported hearing limitations are not affiliated with any type of health insurance system; the majority of those with affiliation to a health insurance service belong to the subsidized group 52.18% and fewer to the contributory group 17.18%. 58.27% of registered persons have not received guidance in how to manage their disability; however, 64.61% have been prescribed special aides, prosthetics, or permanent medica- tions, although only 51.92% actually use them. It is necessary to note that 83.54% of the population believes they still need special help.
82.99% of persons indicate that they are not recovering from their disability, but those that have recovered at- tribute it principally to health services 39.11%, the help of God 26.98%, and the support of their family 20.63%.
Only 25.80% of persons who perceive themselves with hearing limitations have been subject to speech ther- apy and 10.40% to occupational therapy. Persons that currently do not receive rehabilitation services (60.14%), 62.98% indicated that this was due to lack of funds.
The bivariate analysis shows that people that perceive themselves with hearing limitation are more likely to be- long to a low socioeconomic stratus (OR: 1.51; CI 95% 1.33 - 1.59), not be affiliated to a health insurance sys- tem (OR: 1.05; CI 95% 1.03 - 1.07), live alone (OR: 1.32; CI 95% 1.28 - 1.35), can neither read nor write (OR: 1.45; CI 95% 1.43 - 1.47), require the permanent help of another person (OR: 1.20; CI 95% 1.19 - 1.22), do not know the origin of their disability (OR: 1.11; CI 95% 1.11 - 1.13), or have not worked in the last 6 months (OR: 1.28; CI 95% 1.26 - 1.31), as shown in
Variable | Bivariate | Multivariate | |||
---|---|---|---|---|---|
Reference | OR | CI 95% | OR | CI 95% | |
Socioeconomic stratus | 1, 2, 3 or no stratus | 1.41 | 1.33 - 1.50 | 1.33* | 1.25 - 1.42 |
Sex | Female | 0.9 | 0.88 - 0.91 | - | - |
Healthcare affiliation | No | 1.05 | 1.03 - 1.07 | 1.03* | 1.01 - 1.04 |
Knows how to read and write | No | 1.45 | 1.43 - 1.47 | 1.44* | 1.42 - 1.46 |
Requires the permanent help of another person | Yes | 1.2 | 1.19 - 1.22 | - | - |
Currently lives alone | Yes | 1.32 | 1.28 - 1.35 | ||
Currently attends an educational institution | No | 1.28 | 1.25 - 1.3 | - | - |
Knows the origin of their disability | No | 1.11 | 1.1 - 1.13 | - | - |
By occupational disease | Physical conditions or workplace safety | 1.59 | 1.42 - 1.77 | - | - |
By accident | Travel or work | 1.06 | 1.02 - 1.11 | - | - |
Is recovering from their disability | No | 1.49 | 1.47 - 1.52 | - | - |
Currently uses special help | No | 1.36 | 1.34 - 1.38 | - | - |
Has receive guidance in the management of their disability | No | 1.3 | 1.28 - 1.32 | - | - |
Currently uses a rehabilitation center | No | 1.2 | 1.18 - 1.22 | - | - |
Has received health care in the last year | No | 1.18 | 1.16 - 1.20 | - | - |
Has worked in the last 6 months | No | 1.28 | 1.26 - 1.31 | - | - |
workplace illness (OR: 1.59; CI 95% 1.42 - 1.77) and accidents (OR: 1.06; CI 95% 1.02 - 1.11) were associated with limited hearing.
In the multivariate analysis, socioeconomic stratus (OR: 1.33; CI 95% 1.25 - 1.42), illiteracy (OR: 1.44; CI 95% 1.42 - 1.46), and not being affiliated with the healthcare system (OR: 1.03; CI 95% 1.01 - 1.04) continued to be factors associated with limited hearing.
Because communication permits socialization and autonomy of individuals, hearing deficiency impacts society in an important way from economic and psychosocial perspectives [
This limitation has greater impact on young people due to it affecting the education process and the capability of entering the workforce. Given the demographic conditions of the country, a large percentage of people with limited hearing are expected, especially in older adults (It is anticipated, given the demographic conditions of the country, that there will be a large percentage of people with limited hearing, especially in older adults) [
Self-perception of limited hearing found within the registry was 13.6%; however it should be noted that according to the 2005 census it was 17.4%, and that in countries such as Brazil and Cuba values from 4.4% to 4.6%, respectively, have been reported [
Several factors are of note with respect to health services: 1) the small percentage of persons who have recovered due to “other help” different from the social healthcare security system, demonstrate failures in the care of this population, and 2) the small percentage of persons who received occupational therapy and speech therapy services highlight the same drawback. It is possible that this situation is related to the low rate of affiliation in the population to a health insurance system, as well as the low availability of these services in isolated and difficult to reach areas. Additionally, it is possible that the doctor-patient relationship is impeded due to difficulties in communication [
In so far as the causes of limited hearing, the following are known: hereditary or congenital disease, infections during pregnancy, other infections, complications in the perinatal period, otitis media, noise, trauma, cerebro- vascular disease, and old age, among others [
In so far as the factors associated with self-perception of hearing limitation, even with the use of special hearing devices, our study found correlations with low socioeconomic stratus, illiteracy, and the lack of affiliation to a healthcare system, showing the inequity of these persons; several studies have shown that inequalities exist in the socioeconomic level and the use of health insurance services among persons with hearing disability [
The vascular origin hypothesis is plausible because the cochlea is highly vascularized such that it has similar risk factors to other vascular diseases such as coronary disease and infarction [
We wish to highlight that although the country has passed the Law 982 of 2005 [
The present study reveals the inequality, injustice, and social imbalance in the group of people that self-perceive with hearing limitations even with the use of special hearing devices, showing that sustainable and political in- terventions are required, especially in health, education and employment, which will eliminate barriers so that these people have the same opportunities as other Colombians. The state must invest greater effort so that these people can access health, rehabilitation, and education services to facilitate their integration and to not perpetu- ate these conditions.
We thank the Administrative Department of National Statistics (DANE) for providing the information from the Register for the Localization and Characterization of Persons with Disability.
The authors declare that they present no conflict of interest.
The present study was financed by the Unidad Médico-quirúrgica de Otorrinolaringologia S.A.
The present study was not submitted to the Ethical Committee, due to it being a study based on the use of sec- ondary sources, that did not have access to the identity of the subjects, and that did not present a risk to the integrity of those persons.