Prevalence of vision and hearing impairment in Australia: a nationally representative survey of Indigenous and non-Indigenous Australians aged 50 years and older

Abstract

BACKGROUND: Vision and hearing impairment are leading causes of disability, yet nationally representative data in Australia, particularly among Indigenous peoples, are scarce. The Australian Eye and Ear Health Survey aimed to estimate prevalence and risk factors of vision impairment and hearing impairment among Indigenous and non-Indigenous adults aged 50 years and older nationwide. METHODS: This cross-sectional survey used stratified, multistage, random cluster sampling and was conducted across 30 sites in Australia. Stratification was done by geographical location and by Indigenous status to achieve national representativeness. Participants were systematically assessed for any vision impairment (presenting visual acuity <6/12 in the better eye), and any hearing impairment, and moderate or worse hearing impairment (pure tone average>25 decibels hearing level [dB HL], and >40 dB HL in the better ear), respectively. Door-to-door recruitment was the primary recruitment method. Crude and age-standardised prevalence estimates were calculated. Multivariable logistic regression models identified risk and protective factors. FINDINGS: Between Aug 1, 2022, and March 31, 2025, a total of 4519 of 6128 eligible participants were recruited, of whom 617 (13.6%) participants were Indigenous (53.2% [328 participants] female vs 46.8% [289 participants] male; mean age 63.8 [SD 10.6] years) and 3902 (86.4%) participants were non-Indigenous (54.8% [2137 participants] female vs 45.2% [1765 participants] male; mean age 70.5 [9.8] years). The age-standardised prevalence of any vision impairment was 11.1% (95% CI 8.4-14.5) among Indigenous participants, 3.9% (3.3-4.6) among non-Indigenous participants, and 5.2% (4.5-6.0) overall. Any vision impairment was 2.9-times more prevalent among Indigenous than non-Indigenous Australians. The age-standardised prevalences of any hearing impairment, and moderate or worse hearing impairment were 42.8% (95% CI 36.8-49.5) and 14.3% (11.0-18.4) in Indigenous participants; 39.4% (37.3-41.8) and 13.2% (12.0-14.5) in non-Indigenous participants, and 41.7% (39.6-43.9) and 14.2% (13.1-15.5) overall, respectively. Among younger Indigenous participants, moderate or worse hearing impairment was almost three-fold higher than in similarly aged non-Indigenous participants (9.4% [95% CI 5.3-15.8] vs 3.2% [1.8-5.5] among individuals aged 50-59 years), and two-fold higher for Indigenous participants aged 60-69 years (14.3% [9.7-20.4] vs 6.9% [5.4-8.8]). Multivariable-adjusted risk factors in the whole sample were increasing age (both vision impairment and hearing impairment), having diabetes (both), current smoking (hearing impairment), and residence in remote locations (vision impairment). Protective factors were attainment of tertiary education (both), having private health insurance (both), attending an eye examination in the last 12 months (vision impairment), and female sex (hearing impairment). Indigenous status was associated with approximately two to three-fold greater risk of any vision impairment or hearing impairment in age-sex adjusted models, but this effect was no longer statistically significant after adjustment for other covariables. INTERPRETATION: A substantial gap in vision impairment and, to a lesser extent, hearing impairment, persists between Indigenous and non-Indigenous Australians aged 50 years and older. Targeting shared modifiable risk factors and protective factors could reduce this inequity.