Page 81 - 2023-02-中国全科医学

·202· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn January 2023, Vol.26 No.2

is a hidden disease whose damage is irreversible. It is crucial to establish early warnings，screenings and interventions. As of
now，there are few studies carried out on the assessment of hearing loss in the elderly based on risk factors at home and abroad.
There are no standardized measurement tools or perfect scales. Objective Utilizing smart medicine and the WeChat platform，
investigate high-risk factors of hearing loss in the elderly，develop screening software for hearing loss in the elderly，and explore
the screening and management modes of hearing loss in the elderly. Methods Based on cross-sectional survey，five community
health service centers in Pudong New Area of Shanghai were obtained. The tudy was performed from April to December 2019 to
investigate the distribution of risk factors for hearing loss in the elderly in the community，and conditional logic was applied，and
receiver operation charateristic curve（ROC curve）were used for risk stratification. The screening software for hearing loss in the
elderly has been developed using JavaScript language during the period January and June 2020. Verification and evaluation of the
screening software were performed between July 2020 to March 2021. Results The study involved 401 elderly peoplein across-
sectional design. Multivariate Logistic regression analysis revealed that aging〔OR=1.100，95%CI（1.037，1.166）〕，noise
history〔OR=3.886，95%CI（1.077，14.022）〕，non-light diet〔OR=2.445，95%CI（1.127，5.305）〕，hypertension
〔OR=1.8393，95%CI（1.015，3.330）〕，diabetes〔OR=4.310，95%CI（1.817，10.225）〕and hyperuricemia〔OR=3.174，
95%CI（1.030，9.779）〕were independent risk factors（P<0.05）. A total of 18 factors（male，overweight/obesity，living
alone，widowed/divorced，noise history，family history of deafness，non-light diet，no exercise habits，smoking，drinking，
wearing headphones，hypertension，diabetes，hyperlipidemia，cardiovascular and cerebrovascular diseases，hyperuricemia，
hypothyroidism，ototoxic drug use history）were included in the analysis as a result of the difference analysis and literature
review. According to the ROC curve，combined scores of risk factors can predict hearing loss in the elderly with an area under
the curve（AUC） of 0.777〔95%CI（0.721，0.833）〕，and the cut off value is 3.5. According to this study，a cumulative
risk factor score of 4 defined the threshold for predicting hearing loss in the elderly. The elderly were then stratified into those with
low risk of hearing loss（<4）and those with high risk of hearing loss（ ≥ 4）. The software for screening elderly hearing loss
is developed on the WeChat platform. There are four parts in total：risk factors stratification assessment，screening version of
the Hearing Impairment Scale（HHIE-s）for the elderly，general conclusions，and health education. From July to December
2020，a total of 78 elderly people were recruited to evaluatethe hearing loss screening software，with a completion rate of 55.1%
（43/78）.A mode ratecor relation exists between cumulative risk factor scores and HHIE-s scale score （r s =0.360，P=0.018）.
From January to March，2021，a suitability evaluation questionnaire with 8 single item questions was administered to 106 general
practitioners to determine the suitability of hearing loss screening software for the elderly. According to the 5-level Likert scale，
the proportion of respondents who answered “completely agree” to each question is 85.8% （91/106），81.1% （86/106），
71.7% （76/106），68.9% （73/106），68.0% （72/106），59.4% （63/106），15.1% （16/106） and 14.2% （15/106）
respectively. Conclusion There are 18 risk factors for hearing loss in the elderly. The screening software for hearing loss in the
elderly based on WeChat platform has a good effect in early warning of hearing loss in the elderly，which provides a medical basis
for screening for hearing loss in the elderly. Hearing loss screening software can support real-time data transmission，optimize，
and integrate the hierarchical assessment system of risk factors，HHIE-s and WeChat platform for self-health management. The
screening software of hearing loss for the elderly offers general practitioners a new way to manage and control hearing loss provides
a new way of hearing loss management and control for general practitioners at the grassroots.It is appropriate and enforceable.
【Key words】 Hearing tests；Diagnostic screening programs；General practitioners；Screening software；Aged；
Hearing loss；Risk factors

老年听力损失又称年龄相关性听力损失，是继关节 慢性病防治领域的热点名词。在基层医疗中，“大数据
炎、高血压之后，发病率居世界第 3 位的老年性疾病 ［1-2］ 。 + 慢性病管理”模式被大力推崇和逐步完善，该模式使
其定义为因年龄增长而引起听觉器官衰老和退变所导致 得基层慢性病的管控变得更高效，更贴切居民需求，促
的听力下降。疾病早期，患者的主观感觉言语识别能力 进了医患沟通互动 ［7］ 。老年听力损失的发生、发展与
能满足其日常交流，症状易被忽视。听力损失将导致生 个人行为因素、疾病因素等相关，严重影响健康状态，
活能力下降，心理及认知障碍疾病患病率增高，甚至全 病情为相对不可逆且不能自愈 ［8］ 。该疾病可控、可治、
因死亡风险增加 ［3-5］ 。因此老年听力损失是一个重要的 可改善，因此可参照慢性病的管理准则和目标，强化疾
公共健康问题，但尚无治愈方法，有效的筛查管理模式 病管理关口前移。
也少有研究涉及 ［6］ 。 目前国内外基于危险因素进行老年听力损失风险评
近年来，“医疗大数据”和“智能化医疗管理”是 估的研究较少，没有相应的测量工具及量表等。在此背