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Methods. We analyzed data from the 1999-2006 cycles of the National Health and Nutritional Examination Surveys (NHANES), a study designed to assess the health of a nationally representative sample of noninstitutionalized, civilian US residents. 4

Air conduction pure-tone audiometry performed in a sound attenuating booth was administered to a halfsample of all participants aged 20 to 69 years from 1999 through 2004 and all participants 70 years or older from 2005 through 2006 according to established NHANES protocols. A speech-frequency pure-tone average (average of hearing thresholds at 0.5, 1, 2, and 4 kHz) greater than 25 dB in the better ear was defined as hearing impairment per World Health Organization criteria. 5 For all participants 20 years or older from 1999 through 2006, visual acuity was determined for each eye using the individual’s presenting correction (if any) and reassessed after …