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To investigate the prevalence and associated factors of hearing aid acquisition in Chinese older adults.We obtained data from a population-based survey on ear and hearing disorders, which was conducted in 4 provinces of China in 2014 to 2015. Trained examiners conducted pure tone audiometry and audiologists further ascertained for hearing loss. We relied on hearing conditions and audiologists’ recommendations to identify 1503 participants who needed to wear hearing aids.Among those 1503 participants, the estimated prevalence of hearing aid acquisition was 6.5% (95% confidence interval = 5.3%, 7.8%). Urban residency, having severe hearing loss, understanding hearing aid function, and receiving a hearing test in the past 12 months were associated with elevated prevalence of hearing aid acquisition. The top-3 reported reasons for not acquiring a hearing aid were not understanding its function (25.4%), not needing it (22.3%), and not being able to afford it (21.3%).Hearing aid use, as a widespread rehabilitation and treatment of hearing loss, remains a big challenge in China. Apart from providing low-cost hearing aids, more efforts should focus on improving hearing knowledge and disseminating information about hearing aid function among older adults.