基于决策树智能算法的2步纯音听力筛查在社区老年人中的应用

Application of Two-step Pure Tone Hearing Screening Based on Decision Tree Intelligent Algerithm in Community Elderly People

朱蓓;段吉茸;袁春兰;杨建宏;王姣锋;阮清伟;韩朝;保志军;陈洁;张敏;

1:上海市松江区九亭镇社区卫生服务中心

2:上海市浦东新区浦南医院

3:上海复旦大学附属华东医院上海市老年临床医学重点实验室

摘要
目的探索基于决策树智能算法的2步纯音听力筛查在基层医疗单位大范围快速检出中度及以上听力损失者的可行性和科学性。方法对某社区399例老年人进行2步纯音听力筛查(即用0.5 kHz、47 dB HL和2 kHz、42 dB HL两个固定频率和强度的纯音分2步测听)及中文版老年听力障碍筛查量表(Chinese version of the hearing handicap inventory for the elderly screening scale, CHHIE-S)调查,分析筛查出的老年听障者在不同年龄段和性别的分布,以及纯音听力筛查结果与CHHIE-S量表得分的关系,并与既往文献中的结果进行比较。结果使用2步纯音听力筛查对本组老年人中度及以上听力损失的筛出率为29.82%(119/399),除去敏感度误差后,与既往文献报道的用传统标准纯音测听检测社区老年人中度及以上听力损失的检出率(分别为39.32%和39.91%)比较,差异无统计学意义(P=0.052和P=0.594);中度及以上听力损失老年人的检出率随年龄增加而升高(P=0.003),男、女性检出率差异无统计学意义(P=0.067),与文献[年龄:χ2=21.89,CI:-1.8~19.1;男(34.8%),女(20.5%),CI-0.60~1.23]报道一致;纯音听力筛查结果与CHHIE-S得分显著相关(r=0.218,P<0.001),支持2步纯音听力筛查的内敛效度,与文献报道一致(r=0.392,P<0.001)。结论在具备基本测听设备的条件下,将基于决策树智能算法的2步纯音听力筛查用于常规老年人体检中,可以成为一种科学的、有潜力的在基层社区医疗机构推广应用的老年人听力服务模式。
关键词
社区老年人;决策树智能算法;2步纯音听力筛查
基金项目(Foundation):
上海市“科技创新行动计划”临床医学领域项目(17411950702);; 2020年度松江区科技攻关项目(20SJKGG225)
作者
朱蓓;段吉茸;袁春兰;杨建宏;王姣锋;阮清伟;韩朝;保志军;陈洁;张敏;
参考文献

1 Tomioka K,Ikeda H,Hanaie K,et al.The hearing handicap inventory for elderly-screening(HHIE-S) versus a single question:reliability,validity,and relations with quality of life measures in the elderly community[J].Quality of Life Research,2013,22(5):1151-1159.

2 Wang Y,Mo LY,Li YG,et al.Analysing use of the Chinese HHIE-S for hearing screening of elderly in a northeastern industrial area of China[J].International Audiology,2016,56(4):242-247.

3 Ramdoo K,Bowen J,Dale OT,et al.Opportunistic hearing screening in elderly inpatients[J].Sage Open Medicine,2014,1(2):1-5.

4 Abughanem S,Handzel O,Ness L,et al.Smartphone-based audiometric test for screening hearing loss in the elderly[J].Eur Arch Otorhinolaryngol,2016,273(2):333-339.

5 Chou R,Dana T,Bougatsos C.Screening older adults for impaired visual acuity:a review of the evidence for the US Preventive Services Task Force[J].Annals of Internal Medicine,2011,154(5):347-356.

6 Patterson BM,Renaud M.Routine hearing screening in primary care for adult populations using distortion product otoacoustic emissions testing[J].Journal of the American Academy of Nurse Practitioners,2012,24(7):400-404.

7 Zhang M,Bi ZR,Fu XP,et al.A parsimonious approach for screening moderate-to-profound hearing loss in a community-dwelling geriatric population based on a decision tree analysis[J].BMC Geriatrics,2019,19(214):1-11.

8 Kamil RJ,Li L,Lin FR.Association between hearing impairment and frailty in older adults[J].J Am Geriatr Soc,2014,62(6):1186-1188.

9 Gispen FE,Chen DS,Genther DJ,et al.Association between hearing impairment and lower levels of physical activity in older adults[J].Journal of the American Geriatrics Society,2014,62(8):1427-1433.

10 Genther DJ,Betz J,Pratt S,et al.,Association of hearing impairment and mortality in older adults[J].J Gerontol A Biol Sci Med Sci,2015,70(1):85-90.

11 Manrique-Huarte R,Calavia D,Huarte IA,et al.Treatment for hearing loss among the elderly:auditory outcomes and impact on quality of life[J].Audiol Neurootol,2016,21(Suppl 1):29-35.

12 Association ASLH.Guidelines for the identification of hearing impairment/handicap in adult/elderly persons[J].Asha,1989,31(8):59-63.

13 陈建勇,胡娴婷,裴斐,等.中文版老年听力障碍筛查量表临床应用评价[J].听力学及言语疾病杂志,2015,23(5):449-452.

14 Lin FR,Thorpe R,Gordonsalant S,et al.,Hearing loss prevalence and risk factors among older adults in the united states[J].Journals of Gerontology,2011,66(5):582-590.

15 汪国庆,李朝军,官文君,等.筛选型老年听力障碍量表的研译及其信度和效度评价[J].听力学及言语疾病杂志,2014,22(6):568-572.

16 Gopinath B,Rochtchina E,Wang JJ,et al.Prevalence of age-related hearing loss in older adults:blue mountains study[J].Archives of Internal Medicine,2009,169(4):415-416.

17 Goman AM,Lin FR.Prevalence of hearing loss by severity in the united states[J].American Journal of Public Health,2016,106(10):1820-1822.

18 胡向阳,郑晓瑛,马芙蓉,等.我国四省听力障碍流行现况调查[J].中华耳鼻咽喉头颈外科杂志,2016,51(11):819-825.

19 Agrawal Y,Platz EA,Niparko JK.Prevalence of hearing loss and differences by demographic characteristics among US adults:data from the National Health and Nutrition Examination Survey,1999-2004[J].Archives of Internal Medicine,2008,168(14):1522-1530.

20 Bright T,Mactaggart I,Kuper H,et al.,Prevalence of hearing impairment in Mahabubnagar district,Telangana state,India[J].Ear & Hearing,2019,40(1):204-212.

21 So Y,Kim HJ,Kim MS,et al.Discrepancy between self-assessed hearing status and measured audiometric evaluation[J].PLoS One,2017,12(8):1-14.