<p>This study examined the association between hearing impairment (HI) and the risk of cardiometabolic multimorbidity (CMM) in middle-aged and older adults, providing evidence to support early warning and screening of high-risk CMM populations. This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. The analysis included 9,035 participants aged 45 years and older. The association between HI and the risk of CMM was investigated using multivariable Cox proportional hazards regression, Kaplan-Meier survival curves, and subgroup analyses. The results were as follows: Over a median follow-up of 7 years, 382 incident CMM cases were documented. In the fully adjusted Cox proportional hazards model (Model 3), those with mild HI had a 32% increased risk of CMM (Hazard Ratio [HR] = 1.32, 95% Confidence Interval [CI]: 1.06–1.68), while those with severe HI had a 54% increased risk (HR = 1.54, 95% CI: 1.14–2.07). Subgroup analyses revealed that males with severe HI had an increased risk of CMM (HR = 1.72, 95% CI: 1.09–2.27), while females with severe HI also showed an elevated risk (HR = 1.55, 95% CI: 1.07–2.26). Among individuals aged ≥ 60 years, severe HI was associated with a 70% increased risk of CMM (HR = 1.70, 95% CI: 1.15–2.52). Our findings suggest an association between HI and the risk of CMM in middle-aged and older adults, with the association being more pronounced in males with severe HI conditions and individuals aged 60 years or older.</p>