Association between hearing loss, physical activity, and sedentary behavior: a nationally representative cross-sectional study in Chile

BACKGROUND: Hearing loss is common in midlife and older adults and may constrain communication and participation, potentially shaping physical activity and sedentary time; however, population-based evidence remains inconsistent. METHODS: We analyzed a nationally representative sample of Chilean adults aged ≥40 years from the 2016-2017 Chile National Health Survey (n = 3512). Hearing loss was defined by a "no" response to any of three self-report items. Global Physical Activity Questionnaire outcomes included overall physical activity (high/moderate/low), domain-specific energy expenditure (work, transport, leisure; MET-hours/week), and high sedentary behavior (≥8 h/day). We fitted survey-weighted ordinal, gamma (log link), and logistic regression models; effect modification by sex, age, and sleep quality was tested. Sensitivity analyses used inverse probability-of-exposure weighting with gradient-boosted propensity scores. RESULTS: The weighted prevalence of hearing loss was 27.9%. Hearing loss was not associated with overall physical activity level (OR, 1.14; 95% CI, 0.90-1.39) or with domain-specific energy expenditure at work (RR, 0.90; 95% CI, 0.75-1.08), transport (RR, 1.02; 95% CI, 0.83-1.25), or leisure (RR, 1.10; 95% CI, 0.86-1.42). In contrast, hearing loss was associated with high sedentary behavior (OR, 1.81; 95% CI, 1.16-2.82), with similar estimates after weighting (OR, 1.86; 95% CI, 1.18-2.94). Subgroup analyses showed no consistent heterogeneity by sex, age, or sleep quality. CONCLUSION: In Chilean adults aged ≥40 years, self-reported hearing loss was associated with prolonged sedentary time but not with overall or domain-specific physical activity. These findings support integrating hearing care with strategies to reduce sedentary behavior.