Exploring the Relationship Between Hearing Impairment and Low Back Pain in Chinese Middle-Aged and Older Adults: The Mediating Role of Depressive Symptoms

Background Hearing impairment and low back pain are both common in middle-aged and older adults and are associated with poorer function and quality of life. However, longitudinal evidence on whether hearing impairment is associated with subsequent low back pain in Chinese middle-aged and older adults remains limited. Depressive symptoms may represent one pathway linking hearing impairment to later pain outcomes. Methods Using longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, we included 9,650 participants aged 45 years and older who were free of low back pain at baseline. Hearing impairment was assessed using self-reported hearing status and hearing aid use. Low back pain was identified during follow-up based on self-reported bodily pain located in the lower back. Depressive symptoms were assessed at baseline using the CES-D-10. Multivariable logistic regression and mediation analyses were performed after adjustment for demographic factors, lifestyle factors, and chronic conditions. Results During the 7-year follow-up period, 3,101 participants developed low back pain. Hearing impairment was associated with a higher risk of low back pain in the unadjusted model, with an odds ratio of 1.28 and a 95% confidence interval of 1.18 to 1.40. This association remained significant after multivariable adjustment and persisted in the fully adjusted model, with an odds ratio of 1.13 and a 95% confidence interval of 1.03 to 1.24. Mediation analysis indicated that depressive symptoms partially mediated this association, accounting for 18.1% of the total effect. Conclusion In this longitudinal study of Chinese middle-aged and older adults, hearing impairment was associated with subsequent low back pain, and baseline depressive symptoms partially mediated this association. These findings support the importance of considering sensory health and mental health together when evaluating pain risk in ageing populations.