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Demographics | Physical health | Hearing | Cognition | Mobility and balance | Quality of life | Mental health | Social participation and support | Views on hearing loss |


Background

Why impute missing data?

Logistic regression and other statistical methods require complete cases. In our case, with 40+ variables of interest, dropping participants with any missing values leads to a sample size of 200+ cases instead of 500+. There is loss of power, and estimates from models will likely be biased. The goal of missing data imputation is to restore variance of the sample to make it better reflect characteristics of the population (i.e., give accurate estimates of standard errors, CI’s, and p-values).

MICE procedure

‘Multiple Imputation by Chained Equations’

  1. Say there are three variables ‘A’, ‘B’, and ‘C’, each with some missing values. Choose variable ‘A’ to start filling in. Fill in missing values in ‘B’ and ‘C’ with temporary values, such as the mean.

  2. Make an equation A ~ B + C, using observed cases of ‘A’ to predict missing values of ‘A’, including a random component. Move on to predicting missing ‘B’, using B ~ A + C and including predicted ‘A’, again including a random component. Move on to predicting missing ‘C’, using C ~ A + B and predicted ‘A’ and ‘B’. This is one cycle.

  3. Choose the number of cycles, say 10 iterations. At the end of 10 iterations, an “imputed” dataset is formed with no missing values. Choose the number of imputed datasets to form (the same analysis will be conducted on each slightly different dataset, and the results will be pooled). Choose which variables should be used as predictors of other variables. Choose which method to use for predicting missing values, e.g., predictive mean matching. For derived variables such as summed scores, consider whether to impute components first and then calculate derived scores, or impute derived scores. Consider whether there should be an order of which variables to start imputing first.

  4. Check whether the imputed data “converge” (the means and SEs stabilize after a few iterations, and are similar across imputed datasets). Check the distributions and characteristics of imputed data (e.g. integer-only values, floors and ceilings, plausibility), and their similarity to observed data.


1. Pre-imputation work

(i) Evaluate missingness

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Variables of interest Demographics: Age, Gender, Work, Volunteer, Live alone
Physical health: Rating, Multimorbidity score, Subjective vision (loss, rating aided), Subjective hearing (loss, rating aided, rating unaided)
Hearing health: Hearing device use, Hearing device type, Tinnitus past 7 days, 15i-SSQ mean score, SIM mean score, EmoCheQ mean score, HHIE-S total score, BPTA4
Cognitive health: Subjective cognitive impairment, CSRQ mean score
Mobility and balance: Mobility aid use, ABC (balance confidence) mean score
Quality of life: SWLS mean score, WHO overall QoL, WHO health QoL, WHO money, WHO four domains
Mental health: PHQ4, split into anxiety and depression subscores
Social factors: Loneliness, Social Network Index, Social Participation Frequency, Social Participation Types, Social Support MOS mean score
Views: Connections total correct score, Motivations mean score
% Missing data within participants
## 
##   The decimal point is at the |
## 
##    0 | 00004444444444444444444444444444444444444999999999999999999999999999+193
##    2 | 22222222222222222222222222222222222222222277777777777777777777777777+16
##    4 | 000044444999993333333888888888888
##    6 | 222222222222222666666666666666666111111111111111111155555555555
##    8 | 0000000004444888833337777
##   10 | 221199
##   12 | 488
##   14 | 2055
##   16 | 47
##   18 | 65
##   20 | 
##   22 | 5
##   24 | 2
##   26 | 
##   28 | 
##   30 | 
##   32 | 
##   34 | 
##   36 | 
##   38 | 
##   40 | 
##   42 | 9
##   44 | 
##   46 | 
##   48 | 
##   50 | 
##   52 | 
##   54 | 
##   56 | 
##   58 | 
##   60 | 6
##   62 | 
##   64 | 6
##   66 | 87
##   68 | 
##   70 | 8827
##   72 | 6
##   74 | 337
##   76 | 0
##   78 | 
##   80 | 5
##   82 | 
##   84 | 
##   86 | 
##   88 | 
##   90 | 6
##   92 | 
##   94 | 
##   96 | 
##   98 | 66
Missing data patterns


Participants with <26% missing data (n=509):


Participants with >42% missing data (n=18):


(ii) Data cleaning

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Rules
  • For “single-item” variables (e.g. loneliness): NA’s are left as is.
  • For co-morbidity checklist: All responses other than “yes” (NA’s, No, Don’t know) are treated as “no”.
  • For composite variables: If a participant has “NA” for all items, the composite score is also “NA”.
  • WHOQOL-BREF: Follow their protocol for NA’s.
  • For SIM, EmoCheQ, CSRQ, PHQ4, Views on motivations: Impute case mean.
  • For 15i-SSQ: Impute case mean within subscale.
  • For HHIES: Impute case mode within subscale.
  • For ABC: Recode NA’s to 0 (single participant).
  • For Social Network Index: Recode NA’s to “never”.
  • For Social Participation: Recode NA’s to “never”.
  • For Social Support: Recode NA’s to “none”.
  • For Views (Connections): Drop foil item; only correct items credited.
  • For Views (Motivations): Impute mean.


Cleaning details


(iii) Evaluate missingness again

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% Missing data within participants
## 
##   The decimal point is at the |
## 
##    0 | 00000000000000000000000000000000000000000000000000000000000000000000+151
##    2 | 11111111111111111111111111111111111111111111111111111111111111111111+51
##    4 | 222222222222222222222222222222222222222222222
##    6 | 333333333333333333333333333333333333333333333333333333333
##    8 | 333333333333333333333333333
##   10 | 44444444444
##   12 | 55555
##   14 | 
##   16 | 7
##   18 | 8
##   20 | 
##   22 | 
##   24 | 
##   26 | 
##   28 | 
##   30 | 
##   32 | 
##   34 | 
##   36 | 
##   38 | 6
##   40 | 
##   42 | 
##   44 | 
##   46 | 9
##   48 | 
##   50 | 0
##   52 | 1
##   54 | 2
##   56 | 
##   58 | 3333
##   60 | 444
##   62 | 
##   64 | 6
##   66 | 
##   68 | 8
##   70 | 8
##   72 | 
##   74 | 0
##   76 | 
##   78 | 
##   80 | 
##   82 | 
##   84 | 
##   86 | 
##   88 | 66
Missing data patterns


Participants with <20% missing data (n=509):

## # A tibble: 48 × 3
##    variable                        n_miss pct_miss
##    <chr>                            <int>    <num>
##  1 Gender_bin                           0    0    
##  2 Age                                  2    0.393
##  3 Retired_bin                          0    0    
##  4 Volunteer                            0    0    
##  5 Lives_alone_bin                      0    0    
##  6 Phys_health_rating                   7    1.38 
##  7 Multimorbidity_score                 0    0    
##  8 Subj_vision_loss_bin                18    3.54 
##  9 Subj_vision_rating_aided             1    0.196
## 10 Subj_hearing_loss_bin               36    7.07 
## 11 any_hearing_device                   0    0    
## 12 study2_HA                            0    0    
## 13 Subj_hearing_rating_aided_REV      159   31.2  
## 14 Subj_hearing_rating_unaided_REV      8    1.57 
## 15 Tinnitus_past_wk_bin                 0    0    
## 16 ssq_speech_REV                      46    9.04 
## 17 ssq_spatial_REV                     51   10.0  
## 18 ssq_qualities_REV                    3    0.589
## 19 SIM_mean                            12    2.36 
## 20 Emocheq_mean                         8    1.57 
## 21 hhies_emo_total                      0    0    
## 22 hhies_soc_total                      0    0    
## 23 HHIES_total                          0    0    
## 24 positive_SCI_bin                     0    0    
## 25 CSRQ_mean                            0    0    
## 26 Mobility_needs_bin                   0    0    
## 27 ABC_mean                             0    0    
## 28 SWLS_mean                            0    0    
## 29 WHOQOL_overall_qol                   0    0    
## 30 WHOQOL_health_qol                    0    0    
## 31 WHOQOL_Dom1_phys                     0    0    
## 32 WHOQOL_Dom2_psy                      0    0    
## 33 WHOQOL_Dom3_soc                      1    0.196
## 34 WHOQOL_Dom4_env                      0    0    
## 35 WHO_money                            0    0    
## 36 PHQ4_anx_sum                         1    0.196
## 37 PHQ4_dep_sum                         1    0.196
## 38 Lonely_bin                           1    0.196
## 39 Social_network_index                 1    0.196
## 40 Soc_part_freq                        1    0.196
## 41 Soc_part_types                       1    0.196
## 42 Socsupp_mean                         5    0.982
## 43 Connections_total                    9    1.77 
## 44 Motivate_mean                        5    0.982
## 45 study1_HA_bin                       78   15.3  
## 46 study2_HA_bin                        0    0    
## 47 PTA4_better_ear                     73   14.3  
## 48 PTA4_asym                           74   14.5


Participants with >39%% missing data (n=18):


(iv) Justify discarding/retaining participants

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Drop 2 cases that are fully missing
## [1] Progress            Duration.in.seconds Finished           
## <0 rows> (or 0-length row.names)
## # A tibble: 46 × 3
##    variable                        n_miss pct_miss
##    <chr>                            <int>    <num>
##  1 Gender_bin                           0      NaN
##  2 Age                                  0      NaN
##  3 Retired_bin                          0      NaN
##  4 Volunteer                            0      NaN
##  5 Lives_alone_bin                      0      NaN
##  6 Phys_health_rating                   0      NaN
##  7 Multimorbidity_score                 0      NaN
##  8 Subj_vision_loss_bin                 0      NaN
##  9 Subj_vision_rating_aided             0      NaN
## 10 Subj_hearing_loss_bin                0      NaN
## 11 any_hearing_device                   0      NaN
## 12 study2_HA                            0      NaN
## 13 Subj_hearing_rating_aided_REV        0      NaN
## 14 Subj_hearing_rating_unaided_REV      0      NaN
## 15 Tinnitus_past_wk_bin                 0      NaN
## 16 ssq_speech_REV                       0      NaN
## 17 ssq_spatial_REV                      0      NaN
## 18 ssq_qualities_REV                    0      NaN
## 19 SIM_mean                             0      NaN
## 20 Emocheq_mean                         0      NaN
## 21 hhies_emo_total                      0      NaN
## 22 hhies_soc_total                      0      NaN
## 23 HHIES_total                          0      NaN
## 24 positive_SCI_bin                     0      NaN
## 25 CSRQ_mean                            0      NaN
## 26 Mobility_needs_bin                   0      NaN
## 27 ABC_mean                             0      NaN
## 28 SWLS_mean                            0      NaN
## 29 WHOQOL_overall_qol                   0      NaN
## 30 WHOQOL_health_qol                    0      NaN
## 31 WHOQOL_Dom1_phys                     0      NaN
## 32 WHOQOL_Dom2_psy                      0      NaN
## 33 WHOQOL_Dom3_soc                      0      NaN
## 34 WHOQOL_Dom4_env                      0      NaN
## 35 WHO_money                            0      NaN
## 36 PHQ4_anx_sum                         0      NaN
## 37 PHQ4_dep_sum                         0      NaN
## 38 Lonely_bin                           0      NaN
## 39 Social_network_index                 0      NaN
## 40 Soc_part_freq                        0      NaN
## 41 Soc_part_types                       0      NaN
## 42 Socsupp_mean                         0      NaN
## 43 Connections_total                    0      NaN
## 44 Motivate_mean                        0      NaN
## 45 study1_HA_bin                        0      NaN
## 46 study2_HA_bin                        0      NaN
Retain 16 that mostly have age, audiogram, earlier measures
##     Progress Duration.in.seconds Finished
## 45        58                 413        0
## 77        19                 247        0
## 136       58              308782        0
## 153       30                 449        0
## 166       52                 185        0
## 176       53                1693        0
## 187       53              518035        0
## 192       45              504174        0
## 228       13                  96        0
## 246       64                1719        0
## 318       55                 466        0
## 364       55                 988        0
## 405       55                 650        0
## 458        0                 217        0
## 467        1                 540        0
## 483       45                 731        0
## 520       64                6724        0
## 522       70                2376        0
## # A tibble: 46 × 3
##    variable                        n_miss pct_miss
##    <chr>                            <int>    <num>
##  1 Gender_bin                           2     11.1
##  2 Age                                  3     16.7
##  3 Retired_bin                          2     11.1
##  4 Volunteer                            2     11.1
##  5 Lives_alone_bin                      2     11.1
##  6 Phys_health_rating                   4     22.2
##  7 Multimorbidity_score                 0      0  
##  8 Subj_vision_loss_bin                 4     22.2
##  9 Subj_vision_rating_aided             4     22.2
## 10 Subj_hearing_loss_bin                5     27.8
## 11 any_hearing_device                   0      0  
## 12 study2_HA                            0      0  
## 13 Subj_hearing_rating_aided_REV       10     55.6
## 14 Subj_hearing_rating_unaided_REV      5     27.8
## 15 Tinnitus_past_wk_bin                 0      0  
## 16 ssq_speech_REV                      15     83.3
## 17 ssq_spatial_REV                     13     72.2
## 18 ssq_qualities_REV                    8     44.4
## 19 SIM_mean                            13     72.2
## 20 Emocheq_mean                        13     72.2
## 21 hhies_emo_total                     15     83.3
## 22 hhies_soc_total                     15     83.3
## 23 HHIES_total                         15     83.3
## 24 positive_SCI_bin                    15     83.3
## 25 CSRQ_mean                           17     94.4
## 26 Mobility_needs_bin                  17     94.4
## 27 ABC_mean                            17     94.4
## 28 SWLS_mean                           17     94.4
## 29 WHOQOL_overall_qol                  18    100  
## 30 WHOQOL_health_qol                   18    100  
## 31 WHOQOL_Dom1_phys                    18    100  
## 32 WHOQOL_Dom2_psy                     18    100  
## 33 WHOQOL_Dom3_soc                     18    100  
## 34 WHOQOL_Dom4_env                     18    100  
## 35 WHO_money                           18    100  
## 36 PHQ4_anx_sum                        18    100  
## 37 PHQ4_dep_sum                        18    100  
## 38 Lonely_bin                          18    100  
## 39 Social_network_index                18    100  
## 40 Soc_part_freq                       18    100  
## 41 Soc_part_types                      18    100  
## 42 Socsupp_mean                        18    100  
## 43 Connections_total                   18    100  
## 44 Motivate_mean                       18    100  
## 45 study1_HA_bin                        5     27.8
## 46 study2_HA_bin                        0      0


(v) Variable relationships

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Correlations heatmap: Hearing

Correlations heatmap: Physical health
PCA

Note: PC1 and PC2 account for 36% of the total variance.



2. Imputation using MICE

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Current method

  • Use predictors that correlate 0.5 or better to impute missing data in a variable (30 variables); if no such predictors, adjust threshold to 0.4 (3 variables), then 0.3, then 0.2 (2 variables)
    pdf
  • Eight variables are complete and do not require imputing; 2 variables have no predictors that correlate at least r = 0.2 (Subj_vision_loss_bin, Connections_total)
  • MICE settings: total of 5 imputed datasets, with a maximum of 10 iterations per dataset, using predictive means matching to impute missing values

Check imputed data

  • Convergence
    pdf

  • Compare imputed to observed data
    pdf

  • Characteristics of imputed data
    pdf

PCA with standardized imputed data

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PCA

Note: This is only 1 of 5 imputed datasets, but the plots are similar.



3. Predicting hearing aid adoption

Complete cases vs. imputed data

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Note: All participants together; not filtered by hearing aid candidacy.

Regression output (complete cases, n=346)

Non-hearing aid users = 267
Hearing aid users = 79 (22.8%)
Note: Dropped Subj_hearing_rating_aided_REV & SWLS_mean due to VIF > 5


##                               Term Estimate StdError       z      p     OddsRatio CIlower CIupper
## 1                      (Intercept) -24.2964 884.2360 -0.0275 0.9781        0.0000  0.0000     Inf
## 2                       Gender_bin   0.5265   0.4564  1.1536 0.2487        1.6930  0.6921  4.1418
## 3                              Age  -0.0185   0.0346 -0.5336 0.5936        0.9817  0.9172  1.0506
## 4                      Retired_bin   0.0571   0.5098  0.1121 0.9108        1.0588  0.3898  2.8757
## 5                    Volunteer_rec   0.5477   0.2816  1.9448 0.0518        1.7293  0.9957  3.0031
## 6                  Lives_alone_bin  -0.2751   0.5566 -0.4943 0.6211        0.7595  0.2551  2.2608
## 7               Phys_health_rating   0.0966   0.3728  0.2590 0.7956        1.1014  0.5304  2.2868
## 8             Multimorbidity_score  -0.0199   0.1206 -0.1652 0.8688        0.9803  0.7739  1.2417
## 9               Mobility_needs_bin  -0.3204   1.1148 -0.2874 0.7738        0.7258  0.0816  6.4536
## 10                        ABC_mean  -0.0315   0.0261 -1.2055 0.2280        0.9690  0.9206  1.0199
## 11        Subj_vision_rating_aided   0.0508   0.2960  0.1717 0.8637        1.0521  0.5890  1.8795
## 12           Subj_hearing_loss_bin  17.0709 884.2210  0.0193 0.9846 25929968.0135  0.0000     Inf
## 13 Subj_hearing_rating_unaided_REV   1.0591   0.3850  2.7506 0.0059        2.8837  1.3559  6.1334
## 14            Tinnitus_past_wk_bin   0.1555   0.4104  0.3790 0.7047        1.1683  0.5227  2.6112
## 15                 PTA4_better_ear   0.1214   0.0288  4.2225 0.0000        1.1291  1.0672  1.1945
## 16                       PTA4_asym   0.0472   0.0153  3.0891 0.0020        1.0483  1.0174  1.0802
## 17                 SSQ15i_mean_REV  -0.6680   0.1855 -3.6002 0.0003        0.5128  0.3564  0.7376
## 18                    Emocheq_mean  -0.0308   0.2780 -0.1108 0.9118        0.9697  0.5623  1.6721
## 19                     HHIES_total   0.0596   0.0386  1.5445 0.1225        1.0614  0.9841  1.1448
## 20                        SIM_mean  -0.1358   0.1165 -1.1662 0.2435        0.8730  0.6948  1.0968
## 21                positive_SCI_bin   1.1976   0.7118  1.6824 0.0925        3.3122  0.8207 13.3674
## 22                       CSRQ_mean  -0.1344   0.6195 -0.2170 0.8282        0.8742  0.2596  2.9440
## 23                    PHQ4_anx_sum   0.7501   0.2500  3.0009 0.0027        2.1173  1.2972  3.4559
## 24                    PHQ4_dep_sum  -0.5725   0.3340 -1.7137 0.0866        0.5641  0.2931  1.0857
## 25              WHOQOL_overall_qol  -0.4355   0.4717 -0.9233 0.3558        0.6469  0.2567  1.6306
## 26               WHOQOL_health_qol   0.3760   0.3228  1.1648 0.2441        1.4565  0.7736  2.7421
## 27                       WHO_money   0.8039   0.2691  2.9869 0.0028        2.2343  1.3184  3.7865
## 28                    Socsupp_mean   0.2161   0.2994  0.7216 0.4705        1.2412  0.6902  2.2320
## 29            Social_network_index  -0.1362   0.1756 -0.7754 0.4381        0.8727  0.6185  1.2313
## 30                   Soc_part_freq  -0.2681   0.3671 -0.7303 0.4652        0.7648  0.3724  1.5706
## 31                  Soc_part_types   0.0183   0.1582  0.1155 0.9080        1.0184  0.7469  1.3886
## 32                      Lonely_bin  -0.2511   0.6864 -0.3658 0.7145        0.7780  0.2026  2.9868
## 33                   Motivate_mean   0.3051   0.2395  1.2743 0.2026        1.3568  0.8486  2.1694
Regression output (imputed data, n=525)
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)  -0.6224   0.3557 -1.7497 284.6201 0.0813    0.5367  0.2672  1.0776
## 2                       Gender_bin   0.0549   0.0365  1.5051 444.0992 0.1330    1.0564  0.9835  1.1348
## 3                              Age   0.0029   0.0026  1.1257 243.8879 0.2614    1.0029  0.9978  1.0080
## 4                      Retired_bin  -0.0276   0.0370 -0.7458 467.8971 0.4562    0.9728  0.9047  1.0459
## 5                    Volunteer_rec   0.0396   0.0209  1.9002 383.6381 0.0582    1.0404  0.9986  1.0839
## 6                  Lives_alone_bin  -0.0302   0.0420 -0.7186 442.1674 0.4727    0.9703  0.8936  1.0535
## 7               Phys_health_rating  -0.0096   0.0285 -0.3362 146.0093 0.7372    0.9904  0.9366  1.0473
## 8             Multimorbidity_score   0.0041   0.0077  0.5383 468.0730 0.5906    1.0041  0.9891  1.0194
## 9               Mobility_needs_bin  -0.0296   0.0883 -0.3356 141.4920 0.7377    0.9708  0.8165  1.1543
## 10                        ABC_mean  -0.0034   0.0017 -2.0141 292.7450 0.0449    0.9966  0.9933  0.9999
## 11        Subj_vision_rating_aided   0.0079   0.0232  0.3393 470.0114 0.7345    1.0079  0.9631  1.0548
## 12           Subj_hearing_loss_bin   0.0980   0.0504  1.9432 292.4333 0.0529    1.1030  0.9992  1.2175
## 13 Subj_hearing_rating_unaided_REV   0.0968   0.0259  3.7421 302.7899 0.0002    1.1016  1.0471  1.1590
## 14            Tinnitus_past_wk_bin  -0.0528   0.0351 -1.5057 418.2857 0.1329    0.9486  0.8855  1.0161
## 15                 PTA4_better_ear   0.0078   0.0024  3.2462  49.0647 0.0021    1.0078  1.0031  1.0126
## 16                       PTA4_asym   0.0032   0.0016  1.9854  70.8022 0.0510    1.0032  1.0001  1.0064
## 17                 SSQ15i_mean_REV  -0.0708   0.0143 -4.9653 115.1459 0.0000    0.9316  0.9059  0.9581
## 18                    Emocheq_mean  -0.0081   0.0219 -0.3680 249.1891 0.7131    0.9919  0.9503  1.0354
## 19                     HHIES_total   0.0060   0.0029  2.0605 259.0164 0.0403    1.0060  1.0003  1.0118
## 20                        SIM_mean  -0.0021   0.0080 -0.2632 457.9060 0.7925    0.9979  0.9824  1.0137
## 21                positive_SCI_bin   0.0571   0.0604  0.9452 167.0927 0.3459    1.0588  0.9406  1.1918
## 22                       CSRQ_mean  -0.0489   0.0520 -0.9397 120.6915 0.3493    0.9523  0.8600  1.0545
## 23                    PHQ4_anx_sum   0.0586   0.0200  2.9348 120.2604 0.0040    1.0604  1.0196  1.1027
## 24                    PHQ4_dep_sum  -0.0051   0.0218 -0.2348 433.3507 0.8145    0.9949  0.9533  1.0383
## 25              WHOQOL_overall_qol   0.0295   0.0343  0.8600 258.5346 0.3906    1.0299  0.9630  1.1016
## 26               WHOQOL_health_qol   0.0285   0.0240  1.1861 197.2200 0.2370    1.0289  0.9816  1.0785
## 27                       WHO_money   0.0346   0.0199  1.7409 164.3832 0.0836    1.0352  0.9956  1.0764
## 28                    Socsupp_mean   0.0025   0.0234  0.1076 435.4925 0.9143    1.0025  0.9576  1.0496
## 29            Social_network_index  -0.0039   0.0145 -0.2693 171.3773 0.7880    0.9961  0.9682  1.0248
## 30                   Soc_part_freq   0.0024   0.0285  0.0829 259.3816 0.9340    1.0024  0.9479  1.0600
## 31                  Soc_part_types  -0.0052   0.0127 -0.4107 440.2311 0.6815    0.9948  0.9704  1.0199
## 32                      Lonely_bin   0.0063   0.0497  0.1265 171.8542 0.8995    1.0063  0.9129  1.1093
## 33                   Motivate_mean   0.0212   0.0199  1.0665 466.0848 0.2867    1.0214  0.9824  1.0621


Legend: Asterisks denote p < 0.05; crosses denote p [0.05, 0.1]


Accuracy of model predictions

Note: Not really a fair comparison as models and model coefficients are different between complete-cases and imputed data.

## [1] "Complete cases, using median as boundary"
##       predicted
## actual   0   1
##      0 170  97
##      1   3  76
## [1] "Accuracy: 0.711"
## [1] "Sensitivity: 0.962"
## [1] "Specificity: 0.637"

## [1] "Imputed data, using median as boundary"
##       predicted
## actual   0   1
##      0 255 167
##      1   8  95
## [1] "Accuracy: 0.667"
## [1] "Sensitivity: 0.922"
## [1] "Specificity: 0.604"


Grouping by HHIE-S status

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Counts

0-8 no handicap, 10-24 mild to moderate, 26-40 severe

##       HHIES
## UseHA  None MildMod Sev <NA>
##   0     233     148  30   11
##   1      26      62  13    2
##   <NA>    0       0   0    0
## [1] 0.100 0.295 0.302 0.154
Regression output (imputed data, n=525)
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)   0.1676   0.4489  0.3734 222.4966 0.7092    1.1825  0.4905  2.8504
## 2                       Gender_bin  -0.0371   0.0432 -0.8589 197.5811 0.3915    0.9636  0.8854  1.0487
## 3                              Age   0.0002   0.0029  0.0590 207.6885 0.9530    1.0002  0.9945  1.0059
## 4                      Retired_bin  -0.0246   0.0411 -0.5981 220.3189 0.5504    0.9757  0.9002  1.0576
## 5                    Volunteer_rec   0.0308   0.0231  1.3355 212.1983 0.1832    1.0313  0.9856  1.0790
## 6                  Lives_alone_bin   0.0354   0.0463  0.7638 208.4812 0.4458    1.0360  0.9462  1.1345
## 7               Phys_health_rating  -0.0335   0.0313 -1.0695 216.5727 0.2861    0.9671  0.9095  1.0282
## 8             Multimorbidity_score   0.0096   0.0111  0.8626 217.4195 0.3893    1.0096  0.9879  1.0319
## 9               Mobility_needs_bin   0.0211   0.1124  0.1882 221.7430 0.8509    1.0213  0.8194  1.2730
## 10                        ABC_mean  -0.0015   0.0026 -0.5689 204.9233 0.5700    0.9985  0.9934  1.0036
## 11        Subj_vision_rating_aided  -0.0214   0.0280 -0.7629 219.0210 0.4464    0.9788  0.9266  1.0340
## 12           Subj_hearing_loss_bin   0.0868   0.0516  1.6815 169.1639 0.0945    1.0907  0.9858  1.2068
## 13 Subj_hearing_rating_unaided_REV   0.0451   0.0307  1.4672 112.6230 0.1451    1.0461  0.9850  1.1110
## 14            Tinnitus_past_wk_bin  -0.0482   0.0432 -1.1155 190.8091 0.2660    0.9529  0.8756  1.0371
## 15                 PTA4_better_ear   0.0102   0.0031  3.2379  35.4834 0.0026    1.0103  1.0041  1.0164
## 16                       PTA4_asym   0.0043   0.0030  1.4450 100.0494 0.1516    1.0043  0.9984  1.0102
## 17                 SSQ15i_mean_REV  -0.0538   0.0198 -2.7231 134.5648 0.0073    0.9476  0.9116  0.9851
## 18                    Emocheq_mean  -0.0061   0.0287 -0.2122 221.4369 0.8321    0.9939  0.9396  1.0514
## 19                     HHIES_total   0.0041   0.0075  0.5435 216.6440 0.5874    1.0041  0.9895  1.0190
## 20                        SIM_mean   0.0029   0.0093  0.3079 199.0190 0.7585    1.0029  0.9848  1.0214
## 21                positive_SCI_bin   0.1420   0.1035  1.3719 210.3131 0.1716    1.1526  0.9410  1.4118
## 22                       CSRQ_mean  -0.0344   0.0540 -0.6374 216.2184 0.5245    0.9662  0.8691  1.0741
## 23                    PHQ4_anx_sum   0.0515   0.0232  2.2210 206.7393 0.0274    1.0528  1.0060  1.1018
## 24                    PHQ4_dep_sum  -0.0423   0.0306 -1.3825 203.2001 0.1683    0.9586  0.9028  1.0178
## 25              WHOQOL_overall_qol  -0.0148   0.0379 -0.3900 221.7773 0.6969    0.9853  0.9148  1.0613
## 26               WHOQOL_health_qol   0.0053   0.0269  0.1977 211.4222 0.8435    1.0053  0.9537  1.0597
## 27                       WHO_money   0.0440   0.0237  1.8560 211.7084 0.0648    1.0450  0.9976  1.0947
## 28                    Socsupp_mean   0.0169   0.0292  0.5789 195.6673 0.5633    1.0170  0.9605  1.0769
## 29            Social_network_index  -0.0096   0.0157 -0.6140 176.1308 0.5400    0.9904  0.9604  1.0214
## 30                   Soc_part_freq  -0.0126   0.0335 -0.3762 205.1765 0.7072    0.9875  0.9247  1.0545
## 31                  Soc_part_types  -0.0068   0.0141 -0.4822 201.4868 0.6302    0.9932  0.9662  1.0211
## 32                      Lonely_bin  -0.0114   0.0612 -0.1859 222.6215 0.8527    0.9887  0.8769  1.1147
## 33                   Motivate_mean  -0.0208   0.0236 -0.8808 216.2020 0.3794    0.9794  0.9351  1.0258
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)  -1.3803   0.5891 -2.3432 156.9007 0.0204    0.2515  0.0793  0.7980
## 2                       Gender_bin   0.1133   0.0662  1.7120 170.8199 0.0887    1.1200  0.9837  1.2751
## 3                              Age   0.0057   0.0044  1.2739 162.3914 0.2045    1.0057  0.9971  1.0144
## 4                      Retired_bin  -0.0491   0.0667 -0.7365 210.1858 0.4622    0.9521  0.8354  1.0851
## 5                    Volunteer_rec   0.0408   0.0378  1.0786 199.8944 0.2821    1.0416  0.9673  1.1217
## 6                  Lives_alone_bin  -0.1328   0.0769 -1.7279 216.8097 0.0854    0.8756  0.7531  1.0181
## 7               Phys_health_rating   0.0199   0.0488  0.4076 115.2121 0.6843    1.0201  0.9270  1.1225
## 8             Multimorbidity_score  -0.0005   0.0114 -0.0400 205.9110 0.9681    0.9995  0.9774  1.0221
## 9               Mobility_needs_bin   0.0036   0.1420  0.0255  57.5391 0.9797    1.0036  0.7598  1.3257
## 10                        ABC_mean  -0.0045   0.0024 -1.8928 187.6136 0.0599    0.9955  0.9908  1.0002
## 11        Subj_vision_rating_aided   0.0357   0.0381  0.9365 216.0106 0.3501    1.0363  0.9618  1.1167
## 12           Subj_hearing_loss_bin   0.0883   0.1125  0.7848 151.2191 0.4338    1.0923  0.8762  1.3618
## 13 Subj_hearing_rating_unaided_REV   0.1410   0.0454  3.1067 216.3181 0.0021    1.1514  1.0534  1.2586
## 14            Tinnitus_past_wk_bin  -0.0363   0.0557 -0.6510 216.5418 0.5157    0.9644  0.8646  1.0756
## 15                 PTA4_better_ear   0.0087   0.0037  2.3348  51.1203 0.0235    1.0087  1.0014  1.0161
## 16                       PTA4_asym   0.0030   0.0022  1.3464  50.2730 0.1842    1.0030  0.9987  1.0073
## 17                 SSQ15i_mean_REV  -0.0707   0.0204 -3.4631 156.6088 0.0007    0.9317  0.8952  0.9698
## 18                    Emocheq_mean   0.0094   0.0335  0.2819 201.3290 0.7783    1.0094  0.9453  1.0779
## 19                     HHIES_total   0.0031   0.0053  0.5891 189.5581 0.5565    1.0031  0.9927  1.0136
## 20                        SIM_mean  -0.0192   0.0140 -1.3737 204.8236 0.1711    0.9810  0.9544  1.0083
## 21                positive_SCI_bin   0.0922   0.0836  1.1029 210.1273 0.2713    1.0966  0.9309  1.2918
## 22                       CSRQ_mean  -0.0429   0.1001 -0.4285  59.3905 0.6698    0.9580  0.7873  1.1657
## 23                    PHQ4_anx_sum   0.0425   0.0334  1.2700  89.8299 0.2074    1.0434  0.9773  1.1140
## 24                    PHQ4_dep_sum   0.0233   0.0332  0.7016 204.5717 0.4837    1.0236  0.9591  1.0924
## 25              WHOQOL_overall_qol   0.0633   0.0635  0.9977  89.1944 0.3211    1.0653  0.9407  1.2065
## 26               WHOQOL_health_qol   0.0393   0.0418  0.9403 156.3902 0.3485    1.0401  0.9583  1.1289
## 27                       WHO_money   0.0262   0.0312  0.8397 162.6448 0.4023    1.0265  0.9657  1.0913
## 28                    Socsupp_mean  -0.0277   0.0393 -0.7051 210.4527 0.4815    0.9727  0.9006  1.0506
## 29            Social_network_index   0.0067   0.0246  0.2725 193.2635 0.7855    1.0067  0.9593  1.0565
## 30                   Soc_part_freq   0.0233   0.0473  0.4935 144.9131 0.6224    1.0236  0.9329  1.1230
## 31                  Soc_part_types  -0.0084   0.0235 -0.3572 200.9060 0.7213    0.9916  0.9470  1.0384
## 32                      Lonely_bin   0.0368   0.0819  0.4494 144.9796 0.6538    1.0375  0.8836  1.2181
## 33                   Motivate_mean   0.0755   0.0359  2.1033 188.9104 0.0368    1.0784  1.0051  1.1570


Legend: Asterisks denote p < 0.05; crosses denote p [0.05, 0.1]


Grouping by vision status

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Counts
## 
##    0    1 <NA> 
##  215  290   20
Regression output (imputed data, n=525)
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)  -0.3592   0.5758 -0.6238 169.2982 0.5336    0.6982  0.2259  2.1584
## 2                       Gender_bin   0.0209   0.0505  0.4137 176.5291 0.6796    1.0211  0.9249  1.1274
## 3                              Age  -0.0009   0.0040 -0.2238  81.9828 0.8234    0.9991  0.9913  1.0070
## 4                      Retired_bin  -0.0442   0.0538 -0.8226 174.0656 0.4119    0.9568  0.8610  1.0632
## 5                    Volunteer_rec   0.0681   0.0298  2.2886 162.1638 0.0234    1.0705  1.0097  1.1349
## 6                  Lives_alone_bin  -0.1214   0.0625 -1.9427 174.7081 0.0537    0.8857  0.7836  1.0011
## 7               Phys_health_rating  -0.0374   0.0400 -0.9352 170.2876 0.3510    0.9633  0.8907  1.0419
## 8             Multimorbidity_score   0.0157   0.0139  1.1297 176.4648 0.2601    1.0158  0.9885  1.0439
## 9               Mobility_needs_bin  -0.0865   0.1339 -0.6461 166.7874 0.5191    0.9171  0.7054  1.1924
## 10                        ABC_mean  -0.0044   0.0035 -1.2668 124.4677 0.2076    0.9956  0.9888  1.0025
## 11        Subj_vision_rating_aided   0.0050   0.0363  0.1369 178.2075 0.8913    1.0050  0.9360  1.0791
## 12           Subj_hearing_loss_bin   0.1129   0.0712  1.5859 164.7247 0.1147    1.1195  0.9737  1.2872
## 13 Subj_hearing_rating_unaided_REV   0.0135   0.0436  0.3100  46.7996 0.7579    1.0136  0.9306  1.1040
## 14            Tinnitus_past_wk_bin  -0.0348   0.0544 -0.6395 174.6155 0.5233    0.9658  0.8681  1.0745
## 15                 PTA4_better_ear   0.0098   0.0046  2.1281  10.5086 0.0579    1.0098  1.0008  1.0190
## 16                       PTA4_asym   0.0042   0.0025  1.7127  35.0549 0.0956    1.0042  0.9993  1.0091
## 17                 SSQ15i_mean_REV  -0.0505   0.0210 -2.4065 166.5813 0.0172    0.9508  0.9124  0.9907
## 18                    Emocheq_mean   0.0027   0.0335  0.0818 155.7236 0.9349    1.0027  0.9390  1.0708
## 19                     HHIES_total   0.0086   0.0046  1.8660 154.8177 0.0639    1.0086  0.9996  1.0178
## 20                        SIM_mean   0.0043   0.0118  0.3613 152.6866 0.7184    1.0043  0.9813  1.0278
## 21                positive_SCI_bin  -0.0793   0.0961 -0.8252 151.8305 0.4105    0.9238  0.7652  1.1152
## 22                       CSRQ_mean  -0.0433   0.0759 -0.5701  91.6701 0.5700    0.9576  0.8253  1.1112
## 23                    PHQ4_anx_sum   0.0512   0.0275  1.8638 170.6497 0.0641    1.0525  0.9973  1.1108
## 24                    PHQ4_dep_sum  -0.0158   0.0358 -0.4418 165.5642 0.6592    0.9843  0.9176  1.0559
## 25              WHOQOL_overall_qol   0.0132   0.0517  0.2548 153.2040 0.7992    1.0133  0.9156  1.1213
## 26               WHOQOL_health_qol   0.0633   0.0360  1.7557 133.1752 0.0814    1.0653  0.9928  1.1432
## 27                       WHO_money   0.0259   0.0268  0.9680 178.7429 0.3344    1.0262  0.9737  1.0816
## 28                    Socsupp_mean   0.0269   0.0333  0.8080 173.7509 0.4202    1.0273  0.9624  1.0965
## 29            Social_network_index   0.0007   0.0200  0.0354 158.3002 0.9718    1.0007  0.9622  1.0407
## 30                   Soc_part_freq   0.0727   0.0430  1.6908 175.1287 0.0927    1.0754  0.9885  1.1700
## 31                  Soc_part_types  -0.0175   0.0188 -0.9316 177.3309 0.3528    0.9827  0.9471  1.0195
## 32                      Lonely_bin   0.0100   0.0740  0.1346 162.9869 0.8931    1.0101  0.8737  1.1677
## 33                   Motivate_mean  -0.0002   0.0292 -0.0071 179.0708 0.9943    0.9998  0.9442  1.0587
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)  -1.2524   0.4867 -2.5732 144.8155 0.0111    0.2858  0.1101  0.7420
## 2                       Gender_bin   0.1062   0.0549  1.9338 210.8000 0.0545    1.1120  0.9986  1.2384
## 3                              Age   0.0072   0.0036  2.0195 233.2851 0.0446    1.0072  1.0001  1.0144
## 4                      Retired_bin  -0.0444   0.0512 -0.8666 253.8329 0.3870    0.9566  0.8652  1.0575
## 5                    Volunteer_rec   0.0293   0.0307  0.9529 172.8749 0.3420    1.0297  0.9696  1.0936
## 6                  Lives_alone_bin   0.0649   0.0587  1.1056 252.8785 0.2699    1.0671  0.9511  1.1972
## 7               Phys_health_rating   0.0129   0.0413  0.3124  58.8488 0.7559    1.0130  0.9342  1.0984
## 8             Multimorbidity_score  -0.0057   0.0097 -0.5831 239.4511 0.5604    0.9943  0.9756  1.0134
## 9               Mobility_needs_bin   0.0113   0.1283  0.0880  39.9255 0.9303    1.0114  0.7865  1.3005
## 10                        ABC_mean  -0.0022   0.0020 -1.0826 136.9480 0.2809    0.9978  0.9939  1.0017
## 11        Subj_vision_rating_aided  -0.0023   0.0320 -0.0727 251.3298 0.9421    0.9977  0.9370  1.0623
## 12           Subj_hearing_loss_bin   0.0668   0.0715  0.9333 171.9545 0.3520    1.0691  0.9293  1.2299
## 13 Subj_hearing_rating_unaided_REV   0.1215   0.0350  3.4697 216.4681 0.0006    1.1292  1.0543  1.2094
## 14            Tinnitus_past_wk_bin  -0.0453   0.0478 -0.9492 220.9441 0.3436    0.9557  0.8702  1.0496
## 15                 PTA4_better_ear   0.0070   0.0030  2.3490 167.5039 0.0200    1.0070  1.0011  1.0130
## 16                       PTA4_asym   0.0021   0.0021  0.9997 228.8703 0.3185    1.0021  0.9980  1.0062
## 17                 SSQ15i_mean_REV  -0.1049   0.0186 -5.6458 136.9607 0.0000    0.9004  0.8682  0.9338
## 18                    Emocheq_mean  -0.0108   0.0286 -0.3769 217.5983 0.7066    0.9893  0.9353  1.0463
## 19                     HHIES_total   0.0088   0.0039  2.2754 150.6507 0.0243    1.0088  1.0012  1.0166
## 20                        SIM_mean  -0.0093   0.0114 -0.8155 186.1924 0.4158    0.9907  0.9689  1.0131
## 21                positive_SCI_bin   0.1016   0.0773  1.3132 150.9085 0.1911    1.1069  0.9513  1.2880
## 22                       CSRQ_mean   0.0397   0.0740  0.5359  82.3046 0.5935    1.0405  0.9000  1.2029
## 23                    PHQ4_anx_sum   0.0760   0.0284  2.6749  66.3161 0.0094    1.0790  1.0205  1.1407
## 24                    PHQ4_dep_sum  -0.0104   0.0292 -0.3552 190.0976 0.7229    0.9897  0.9346  1.0479
## 25              WHOQOL_overall_qol   0.0959   0.0497  1.9311 118.9498 0.0558    1.1006  0.9985  1.2133
## 26               WHOQOL_health_qol   0.0196   0.0326  0.6014 162.1710 0.5484    1.0198  0.9567  1.0871
## 27                       WHO_money   0.0278   0.0284  0.9808  96.1692 0.3291    1.0282  0.9725  1.0870
## 28                    Socsupp_mean  -0.0203   0.0353 -0.5750 224.0691 0.5658    0.9799  0.9144  1.0501
## 29            Social_network_index   0.0049   0.0208  0.2374 125.3419 0.8127    1.0049  0.9648  1.0467
## 30                   Soc_part_freq  -0.0453   0.0406 -1.1173 134.1840 0.2659    0.9557  0.8826  1.0349
## 31                  Soc_part_types   0.0026   0.0179  0.1455 245.9398 0.8845    1.0026  0.9680  1.0384
## 32                      Lonely_bin  -0.0350   0.0670 -0.5223 189.6238 0.6021    0.9656  0.8468  1.1011
## 33                   Motivate_mean   0.0238   0.0283  0.8426 236.5224 0.4003    1.0241  0.9688  1.0825


Legend: Asterisks denote p < 0.05; crosses denote p [0.05, 0.1]


Variable selection: Predicting HA adoption

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Penalized logistic regression (LASSO) with 5-fold cross-validation was conducted across 100 lambda (penalty) values. The lambda value that led to the best-fitting model (with lowest cross-validation error) was 0.044, which corresponds to a model with 13 predictors:

Regression output (13 selected) (imputed data, n=525)
##                               Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                      (Intercept)  -0.7791   0.1798 -4.3326 459.4624 0.0000    0.4588  0.3225  0.6527
## 2                       Gender_bin   0.0300   0.0327  0.9184 454.7251 0.3589    1.0305  0.9665  1.0987
## 3                              Age   0.0025   0.0021  1.1975 352.0198 0.2319    1.0025  0.9984  1.0066
## 4                    Volunteer_rec   0.0378   0.0180  2.0979 506.9027 0.0364    1.0385  1.0025  1.0758
## 5                  Lives_alone_bin  -0.0308   0.0390 -0.7916 485.7513 0.4290    0.9697  0.8983  1.0467
## 6            Subj_hearing_loss_bin   0.0772   0.0483  1.6001 275.9907 0.1107    1.0803  0.9827  1.1875
## 7  Subj_hearing_rating_unaided_REV   0.0965   0.0249  3.8754 276.5074 0.0001    1.1013  1.0489  1.1564
## 8                  PTA4_better_ear   0.0083   0.0023  3.6845  63.9576 0.0005    1.0083  1.0038  1.0129
## 9                        PTA4_asym   0.0035   0.0016  2.2278  67.5542 0.0292    1.0035  1.0004  1.0067
## 10                 SSQ15i_mean_REV  -0.0775   0.0122 -6.3466 260.8414 0.0000    0.9254  0.9036  0.9478
## 11                     HHIES_total   0.0053   0.0024  2.2187 381.4252 0.0271    1.0053  1.0006  1.0101
## 12                    PHQ4_anx_sum   0.0470   0.0153  3.0756  96.5966 0.0027    1.0481  1.0172  1.0800
## 13                       WHO_money   0.0401   0.0181  2.2155 155.8128 0.0282    1.0409  1.0046  1.0785
## 14                    Socsupp_mean   0.0169   0.0205  0.8228 424.5504 0.4111    1.0170  0.9770  1.0587


Limiting the model to the 8 predictors with p < 0.05, all 8 predictors remain significant in a standard logistic regression model.

Regression output (8 selected) (imputed data, n=525)
##                              Term Estimate StdError       t       df      p OddsRatio CIlower CIupper
## 1                     (Intercept)  -0.6185   0.1085 -5.7002 112.1901 0.0000    0.5388  0.4355  0.6664
## 2                   Volunteer_rec   0.0379   0.0178  2.1249 503.9135 0.0341    1.0386  1.0030  1.0755
## 3 Subj_hearing_rating_unaided_REV   0.1129   0.0227  4.9790 291.6845 0.0000    1.1195  1.0708  1.1705
## 4                 PTA4_better_ear   0.0104   0.0020  5.2938  67.5750 0.0000    1.0105  1.0065  1.0144
## 5                       PTA4_asym   0.0039   0.0015  2.5424  96.9679 0.0126    1.0039  1.0010  1.0069
## 6                 SSQ15i_mean_REV  -0.0784   0.0124 -6.3279 200.0383 0.0000    0.9246  0.9024  0.9473
## 7                     HHIES_total   0.0054   0.0024  2.2734 298.3260 0.0237    1.0054  1.0007  1.0102
## 8                    PHQ4_anx_sum   0.0422   0.0152  2.7789  82.2740 0.0068    1.0431  1.0125  1.0746
## 9                       WHO_money   0.0519   0.0172  3.0212 174.7458 0.0029    1.0533  1.0184  1.0894



Accuracy of model predictions

## [1] "Imputed data, 8 predictors, using median as boundary to classify 0 or 1"
##       predicted
## actual   0   1
##      0 253 169
##      1  10  93
## [1] "Accuracy: 0.659"
## [1] "Sensitivity: 0.903"
## [1] "Specificity: 0.6"


4. Special populations

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The standard relationship, HA ~ BPTA4

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Plots showing thresholds for BPTA4, Asymmetry, HHIES


  • Of the three variables, BPTA4 is the best standalone predictor of HA adoption.
  • Legend: Red = HA adopters. Lines are thresholds for highest area-under-curve. Complete cases only, n=436.

Comparing three predictors: BPTA4, Asymmetry, HHIES


  • On their own, BPTA4 and HHIES help predict HA adoption. On its own, PTA4 asymmetry doesn’t.
## Analysis of Deviance Table
## 
## Model 1: study2_HA_bin ~ 1
## Model 2: study2_HA_bin ~ PTA4_better_ear
##   Resid. Df Resid. Dev Df Deviance  Pr(>Chi)    
## 1       435     424.45                          
## 2       434     351.11  1   73.345 < 2.2e-16 ***
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
## Analysis of Deviance Table
## 
## Model 1: study2_HA_bin ~ 1
## Model 2: study2_HA_bin ~ PTA4_asym
##   Resid. Df Resid. Dev Df Deviance Pr(>Chi)  
## 1       435     424.45                       
## 2       434     420.80  1   3.6462   0.0562 .
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
## Analysis of Deviance Table
## 
## Model 1: study2_HA_bin ~ 1
## Model 2: study2_HA_bin ~ HHIES_total
##   Resid. Df Resid. Dev Df Deviance   Pr(>Chi)    
## 1       435     424.45                           
## 2       434     407.67  1   16.779 0.00004199 ***
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
  • When BPTA4 is the main predictor, adding HHIES doesn’t help predict HA adoption, while adding PTA4 asymmetry does help a little.
## Analysis of Deviance Table
## 
## Model 1: study2_HA_bin ~ PTA4_better_ear
## Model 2: study2_HA_bin ~ PTA4_better_ear + HHIES_total
##   Resid. Df Resid. Dev Df Deviance Pr(>Chi)
## 1       434     351.11                     
## 2       433     349.44  1    1.664   0.1971
## 
## Call:
## glm(formula = study2_HA_bin ~ PTA4_better_ear + HHIES_total, 
##     family = "binomial", data = compdata_3hear)
## 
## Coefficients:
##                 Estimate Std. Error z value         Pr(>|z|)    
## (Intercept)     -4.36669    0.44332  -9.850          < 2e-16 ***
## PTA4_better_ear  0.10502    0.01517   6.921 0.00000000000449 ***
## HHIES_total      0.01952    0.01505   1.297            0.195    
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
## 
## (Dispersion parameter for binomial family taken to be 1)
## 
##     Null deviance: 424.45  on 435  degrees of freedom
## Residual deviance: 349.44  on 433  degrees of freedom
## AIC: 355.44
## 
## Number of Fisher Scoring iterations: 5
## Analysis of Deviance Table
## 
## Model 1: study2_HA_bin ~ PTA4_better_ear
## Model 2: study2_HA_bin ~ PTA4_better_ear + PTA4_asym
##   Resid. Df Resid. Dev Df Deviance Pr(>Chi)  
## 1       434     351.11                       
## 2       433     345.57  1   5.5349  0.01864 *
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
## 
## Call:
## glm(formula = study2_HA_bin ~ PTA4_better_ear + PTA4_asym, family = "binomial", 
##     data = compdata_3hear)
## 
## Coefficients:
##                  Estimate Std. Error z value           Pr(>|z|)    
## (Intercept)     -4.508478   0.456061  -9.886            < 2e-16 ***
## PTA4_better_ear  0.113766   0.014962   7.604 0.0000000000000288 ***
## PTA4_asym        0.022765   0.009159   2.486             0.0129 *  
## ---
## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
## 
## (Dispersion parameter for binomial family taken to be 1)
## 
##     Null deviance: 424.45  on 435  degrees of freedom
## Residual deviance: 345.57  on 433  degrees of freedom
## AIC: 351.57
## 
## Number of Fisher Scoring iterations: 5
Plot showing better and worse ear PTA4, and HA status


“Red flag” variables

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Note: n=449 who have audiograms available.

Using BPTA4 as the standalone predictor of HA adoption, the sample can be divided into four groups:
* predicted to adopt HA because BPTA4 > 26.875, or not predicted to adopt HA because BPTA4 < 26.875
* actual HA adopters, or non-adopters

##                predict HA adopt
## actual HA adopt   0   1
##               0 280  85
##               1  23  61
Distributions of BPTA4
## $HA_poorBPTA
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##   27.50   31.25   35.00   35.06   38.75   51.25 
## 
## $nonHA_poorBPTA
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##   27.50   30.00   33.75   33.94   36.25   52.50 
## 
## $nonHA_goodBPTA
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##    2.50   11.25   16.25   16.30   21.25   26.25 
## 
## $HA_goodBPTA
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##   10.00   16.88   20.00   19.57   23.12   26.25


Continuous and ordinal variables have been dichotomized according to these cut-offs:
* PTA4 asymmetry ≥ 20 dB HL
* HHIES ≥ 10
* PHQ4 (anxiety and depression) subscores ≥ 3
* Social participation of less than once per week in any activity
* Mean social support of less than “some of the time” (< 2.5 out of 5 on average, with 3 being “some of the time”)
* Generally, any WHOQOL-BREF responses that are in the worst 2 of 5 categories. There are a few exceptions, where it’s clear that the worst 3 categories are red flags according to the distribution (physical pain, medical treatment, money, information access, getting around, health services, transport, negative mood).
* In the list of motivations for seeking help, being “not at all” or only “slightly” motivated.

Counts of participants experiencing each red flag, ordered high to low
## [1] "Test of proportions conducted for first two columns"
## [1] "Test of proportions generally requires 5 positive cases per group"
##                  Variable HA_poorPTA nonHA_poorPTA nonHA_goodPTA HA_goodPTA  chisq pvalue
## 3               HHIES_bin         43            53            98         16 0.7145 0.3979
## 7            PHQ4_anx_bin         26            23           100         11 3.1917 0.0740
## 19      Motiv_fatigue_bin         20            19            38          2 1.4779 0.2241
## 2    Tinnitus_past_wk_bin         15            35            82         10 3.6334 0.0566
## 20       Motiv_health_bin         15            22            43          5 0.0000 1.0000
## 18      Motiv_sadfrus_bin         14            12            23          5 1.3377 0.2474
## 21         Motiv_cogn_bin         14            19            27          4 0.0000 1.0000
## 42     WHO_satisf_sex_bin         13            19            60          4 0.0000 1.0000
## 17       Motiv_social_bin         12             7            22          1 3.1554 0.0757
## 8            PHQ4_dep_bin         11            23            74          7 1.1537 0.2828
## 13         Motiv_lect_bin         11            15            34          2 0.0000 1.0000
## 16      Motiv_friends_bin         11             9            12          1 1.0947 0.2954
## 37   WHO_sleep_satisf_bin         11            21            57          8 0.5753 0.4482
## 9              Lonely_bin          9            19            52          7 0.8782 0.3487
## 12      Motiv_convers_bin          9             8            25          0 0.5343 0.4648
## 14      Motiv_tvradmu_bin          9            17            26          2 0.3574 0.5500
## 24      WHO_phys_pain_bin          9            21            57          5 1.5879 0.2076
## 47   WHO_neg_feelings_bin          9            15            45          4 0.0570 0.8113
## 25  WHO_med_treatment_bin          8            18            51          2 1.0742 0.3000
## 33          WHO_money_bin          8            22            41          4 2.8071 0.0938
## 6        positive_SCI_bin          7            11            25          4 0.0001 0.9916
## 23  WHO_health_satisf_bin          7            16            32          4 0.9442 0.3312
## 45  WHO_access_health_bin          6            10            39          3 0.0099 0.9209
## 4      Mobility_needs_bin          5             4            14          1 0.2664 0.6058
## 15       Motiv_family_bin          5             8            12          0 0.0000 1.0000
## 34    WHO_information_bin          5             6            11          0 0.0000 1.0000
## 22            WHO_qol_bin          4             4             5          0 0.0135 0.9075
## 39  WHO_capacity_work_bin          4             5            21          1 0.0000 1.0000
## 44   WHO_living_place_bin          4             6             8          3 0.0000 1.0000
## 5   Poor_aided_vision_bin          3             1             8          0 0.7258 0.3942
## 10        MOS_socsupp_bin          3            11            10          4 1.7926 0.1806
## 27     WHO_meaningful_bin          3             6            11          0 0.0330 0.8559
## 31         WHO_energy_bin          3             6            13          2 0.0330 0.8559
## 38    WHO_ability_ADL_bin          3             5            12          0 0.0000 1.0000
## 1           Asymmetry_bin          2             5             8          4 0.1112 0.7387
## 11   CCHS_socpartfreq_bin          2             4            13          2 0.0000 0.9954
## 28    WHO_concentrate_bin          2             3             6          1 0.0000 1.0000
## 30    WHO_healthy_env_bin          2             1             1          0 0.0851 0.7705
## 32    WHO_body_appear_bin          2             7            14          2 0.7732 0.3792
## 36     WHO_get_around_bin          2             5            11          2 0.1112 0.7387
## 40    WHO_satisf_self_bin          2             6            16          2 0.3859 0.5345
## 41   WHO_satisf_relat_bin          2            11            12          2 2.9833 0.0841
## 26     WHO_enjoy_life_bin          1             5             5          1 0.7244 0.3947
## 29      WHO_feel_safe_bin          1             2             3          0 0.0000 1.0000
## 35        WHO_leisure_bin          1             7            13          2 1.8456 0.1743
## 43 WHO_satisf_support_bin          1             4             9          1 0.2954 0.5868
## 46      WHO_transport_bin          0             3            13          3 0.7942 0.3728
Percentages of participants experiencing each red flag, ordered high to low
## [1] "Test of proportions conducted for first two columns"
## [1] "Test of proportions generally requires 5 positive cases per group"
##                  Variable HA_poorPTA_p nonHA_poorPTA_p nonHA_goodPTA_p HA_goodPTA_p  chisq pvalue
## 3               HHIES_bin         70.5            62.4            35.0         69.6 0.7145 0.3979
## 7            PHQ4_anx_bin         42.6            27.1            35.7         47.8 3.1917 0.0740
## 19      Motiv_fatigue_bin         32.8            22.4            13.6          8.7 1.4779 0.2241
## 2    Tinnitus_past_wk_bin         24.6            41.2            29.3         43.5 3.6334 0.0566
## 20       Motiv_health_bin         24.6            25.9            15.4         21.7 0.0000 1.0000
## 18      Motiv_sadfrus_bin         23.0            14.1             8.2         21.7 1.3377 0.2474
## 21         Motiv_cogn_bin         23.0            22.4             9.6         17.4 0.0000 1.0000
## 42     WHO_satisf_sex_bin         21.3            22.4            21.4         17.4 0.0000 1.0000
## 17       Motiv_social_bin         19.7             8.2             7.9          4.3 3.1554 0.0757
## 8            PHQ4_dep_bin         18.0            27.1            26.4         30.4 1.1537 0.2828
## 13         Motiv_lect_bin         18.0            17.6            12.1          8.7 0.0000 1.0000
## 16      Motiv_friends_bin         18.0            10.6             4.3          4.3 1.0947 0.2954
## 37   WHO_sleep_satisf_bin         18.0            24.7            20.4         34.8 0.5753 0.4482
## 9              Lonely_bin         14.8            22.4            18.6         30.4 0.8782 0.3487
## 12      Motiv_convers_bin         14.8             9.4             8.9          0.0 0.5343 0.4648
## 14      Motiv_tvradmu_bin         14.8            20.0             9.3          8.7 0.3574 0.5500
## 24      WHO_phys_pain_bin         14.8            24.7            20.4         21.7 1.5879 0.2076
## 47   WHO_neg_feelings_bin         14.8            17.6            16.1         17.4 0.0570 0.8113
## 25  WHO_med_treatment_bin         13.1            21.2            18.2          8.7 1.0742 0.3000
## 33          WHO_money_bin         13.1            25.9            14.6         17.4 2.8071 0.0938
## 6        positive_SCI_bin         11.5            12.9             8.9         17.4 0.0001 0.9916
## 23  WHO_health_satisf_bin         11.5            18.8            11.4         17.4 0.9442 0.3312
## 45  WHO_access_health_bin          9.8            11.8            13.9         13.0 0.0099 0.9209
## 4      Mobility_needs_bin          8.2             4.7             5.0          4.3 0.2664 0.6058
## 15       Motiv_family_bin          8.2             9.4             4.3          0.0 0.0000 1.0000
## 34    WHO_information_bin          8.2             7.1             3.9          0.0 0.0000 1.0000
## 22            WHO_qol_bin          6.6             4.7             1.8          0.0 0.0135 0.9075
## 39  WHO_capacity_work_bin          6.6             5.9             7.5          4.3 0.0000 1.0000
## 44   WHO_living_place_bin          6.6             7.1             2.9         13.0 0.0000 1.0000
## 5   Poor_aided_vision_bin          4.9             1.2             2.9          0.0 0.7258 0.3942
## 10        MOS_socsupp_bin          4.9            12.9             3.6         17.4 1.7926 0.1806
## 27     WHO_meaningful_bin          4.9             7.1             3.9          0.0 0.0330 0.8559
## 31         WHO_energy_bin          4.9             7.1             4.6          8.7 0.0330 0.8559
## 38    WHO_ability_ADL_bin          4.9             5.9             4.3          0.0 0.0000 1.0000
## 1           Asymmetry_bin          3.3             5.9             2.9         17.4 0.1112 0.7387
## 11   CCHS_socpartfreq_bin          3.3             4.7             4.6          8.7 0.0000 0.9954
## 28    WHO_concentrate_bin          3.3             3.5             2.1          4.3 0.0000 1.0000
## 30    WHO_healthy_env_bin          3.3             1.2             0.4          0.0 0.0851 0.7705
## 32    WHO_body_appear_bin          3.3             8.2             5.0          8.7 0.7732 0.3792
## 36     WHO_get_around_bin          3.3             5.9             3.9          8.7 0.1112 0.7387
## 40    WHO_satisf_self_bin          3.3             7.1             5.7          8.7 0.3859 0.5345
## 41   WHO_satisf_relat_bin          3.3            12.9             4.3          8.7 2.9833 0.0841
## 26     WHO_enjoy_life_bin          1.6             5.9             1.8          4.3 0.7244 0.3947
## 29      WHO_feel_safe_bin          1.6             2.4             1.1          0.0 0.0000 1.0000
## 35        WHO_leisure_bin          1.6             8.2             4.6          8.7 1.8456 0.1743
## 43 WHO_satisf_support_bin          1.6             4.7             3.2          4.3 0.2954 0.5868
## 46      WHO_transport_bin          0.0             3.5             4.6         13.0 0.7942 0.3728
Plot of most common red flags, by four groups (BPTA x HA)


Variables where the two groups with poor BPTA have at least 10% of people reporting each red flag (excluding HHIES and motivation variables for now). For comparison, the same variables have been chosen for the two groups with good BPTA.

⭐Plot of frequency of red flags, by fewer or more red flags


Below: Median and mean number of red flags per group, and overall cumulative distribution (excluding HHIES and motivation variables for now).

##    HA_poorBPTA nonHA_poorBPTA nonHA_goodBPTA    HA_goodBPTA 
##              2              2              2              2
##    HA_poorBPTA nonHA_poorBPTA nonHA_goodBPTA    HA_goodBPTA 
##           3.21           4.35           3.40           4.61
##    NumRedFlags Frequency CumulPercent
## 1            0        90         20.0
## 2            1       106         43.7
## 3            2        60         57.0
## 4            3        48         67.7
## 5            4        32         74.8
## 6            5        24         80.2
## 7            6        18         84.2
## 8            7        11         86.6
## 9            8        10         88.9
## 10           9         5         90.0
## 11          10         2         90.4
## 12          11         9         92.4
## 13          12         5         93.5
## 14          13         2         94.0
## 15          14         4         94.9
## 16          15         4         95.8
## 17          16         6         97.1
## 18          17         3         97.8
## 19          20         2         98.2
## 20          21         2         98.7
## 21          22         1         98.9
## 22          23         2         99.3
## 23          24         1         99.6
## 24          27         2        100.0

The plot shows n=256 with 2 red flags or fewer, and n=193 with 3 or more red flags. (The table below the plot shows the age distributions of the two groups).

## $fewer_flags
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max.    NA's 
##   52.00   62.00   67.00   67.21   73.00   84.00       2 
## 
## $more_flags
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max.    NA's 
##   52.00   59.75   66.00   65.76   71.00   89.00       1
⭐Plot of frequency of red flags, by fewer or more flags, poor BPTA only


Narrowing it down to only n=146 with poor BPTA:

##                 Red flag group
## HA group         fewer_flags more_flags
##   HA_poorBPTA             39         22
##   nonHA_poorBPTA          47         38

Plot of individuals with red flags


BPTA4 thresholds for HA adoption

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Table of thresholds


##    Threshold Sensitivity Specificity Accuracy
## 1       -Inf  1.00000000 0.000000000       NA
## 2      3.125  1.00000000 0.002739726    18.93
## 3      4.375  1.00000000 0.008219178    19.38
## 4      5.625  1.00000000 0.024657534    20.71
## 5      6.875  1.00000000 0.049315068    22.72
## 6      8.125  1.00000000 0.068493151    24.28
## 7      9.375  1.00000000 0.104109589    27.17
## 8     10.625  0.98809524 0.156164384    31.18
## 9     11.875  0.98809524 0.202739726    34.97
## 10    13.125  0.97619048 0.271232877    40.31
## 11    14.000  0.96428571 0.317808219    43.88
## 12    14.625  0.96428571 0.320547945    44.10
## 13    15.625  0.96428571 0.369863014    48.11
## 14    16.875  0.92857143 0.424657534    51.89
## 15    18.125  0.90476190 0.457534247    54.12
## 16    19.375  0.88095238 0.506849315    57.68
## 17    20.625  0.85714286 0.542465753    60.13
## 18    21.875  0.80952381 0.591780822    63.25
## 19    23.125  0.79761905 0.630136986    66.15
## 20    24.375  0.73809524 0.665753425    67.93
## 21    25.625  0.73809524 0.712328767    71.71
## 22    26.875  0.72619048 0.767123288    75.95
## 23    28.125  0.69047619 0.791780822    77.28
## 24    29.375  0.59523810 0.819178082    77.73
## 25    30.625  0.55952381 0.852054795    79.73
## 26    31.875  0.46428571 0.873972603    79.73
## 27    33.125  0.40476190 0.882191781    79.29
## 28    34.375  0.36904762 0.917808219    81.51
## 29    35.625  0.30952381 0.923287671    80.85
## 30    36.875  0.23809524 0.947945205    81.51
## 31    38.125  0.19047619 0.956164384    81.29
## 32    39.375  0.15476190 0.964383562    81.29
## 33    40.500  0.08333333 0.972602740    80.62
## 34    41.125  0.08333333 0.975342466    80.85
## 35    42.500  0.07142857 0.978082192    80.85
## 36    44.375  0.05952381 0.980821918    80.85
## 37    45.625  0.04761905 0.986301370    81.07
## 38    46.875  0.03571429 0.991780822    81.29
## 39    48.125  0.02380952 0.994520548    81.29
## 40    49.375  0.01190476 0.994520548    81.07
## 41    50.625  0.01190476 0.997260274    81.29
## 42    51.875  0.00000000 0.997260274    81.07
## 43       Inf  0.00000000 1.000000000       NA

Split by: Fewer or more red flags


Split by: Women or men


## 
##   Men Women 
##   183   266

Split by: Younger or older


##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max.    NA's 
##   52.00   61.00   67.00   66.59   72.00   89.00       3

Split by: Retirement status


## 
##    0    1 <NA> 
##  168  281    0

Split by: Anxiety and depression


## 
##    0    1 <NA> 
##  275  160   14

## 
##    0    1 <NA> 
##  320  115   14

Split by: Money


## 
##    0    1 <NA> 
##  361   75   13


5. CLSA variables

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https://www.clsa-elcv.ca/wp-content/uploads/2024/01/CLSA_DataAvailabilityTable_v5.2_2024Dec17.pdf

Variable list


Note: Preliminary skim of CLSA variables table…

CLSA Multidomain Item wording
AGE Age
Marital status Marital status
Income WHO money
Wealth WHO money
SEX Gender
General Health General Health
Vision Subjective vision?
Hearing HRG Subjective hearing?
Functional Status WHO?
Sleep WHO sleep
Pain and Discomfort WHO pain
Falls ABC scale
Health Care Utilization WHO?
Life Space Index n/a
Self-reported Chronic Conditions Morbidity count
Mental Health WHO negative mood?
Depression PHQ4
Loneliness Scale Loneliness Scale
Generalized Anxiety Disorder PHQ4
Subjective Cognitive Decline Subjective Cognitive Decline
Retirement Status Retirement Status
Social Networks Social Network Index
Social Support MOS Social Support
Social Participation CCHS Social Participation
Transportation, Mobility, Migration WHO transport
Hearing COM ??