Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004

Arch Intern Med. 2009 May 25;169(10):938-44. doi: 10.1001/archinternmed.2009.66.


Background: Balance dysfunction can be debilitating and can lead to catastrophic outcomes such as falls. The inner ear vestibular system is an important contributor to balance control. However, to our knowledge, the prevalence of vestibular dysfunction in the United States and the magnitude of the increased risk of falling associated with vestibular dysfunction have never been estimated. The objective of this study was to determine the prevalence of vestibular dysfunction among US adults, evaluate differences by sociodemographic characteristics, and estimate the association between vestibular dysfunction and risk of falls.

Methods: We included data from the 2001-2004 National Health and Nutrition Examination Surveys, which were cross-sectional surveys of US adults aged 40 years and older (n = 5086). The main outcome measure was vestibular function as measured by the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces.

Results: From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had vestibular dysfunction. Odds of vestibular dysfunction increased significantly with age, were 40.3% lower in individuals with more than a high school education, and were 70.0% higher among people with diabetes mellitus. Participants with vestibular dysfunction who were clinically symptomatic (ie, reported dizziness) had a 12-fold increase in the odds of falling.

Conclusions: Vestibular dysfunction, as measured by a simple postural metric, is common among US adults. Vestibular dysfunction significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting older individuals. These data suggest the importance of diagnosing, treating, and potentially screening for vestibular deficits to reduce the burden of fall-related injuries and deaths in the United States.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Dizziness / epidemiology*
  • Dizziness / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys*
  • Postural Balance / physiology*
  • Prevalence
  • Retrospective Studies
  • United States / epidemiology
  • Vestibular Diseases / epidemiology*
  • Vestibular Diseases / physiopathology
  • Vestibule, Labyrinth / physiopathology*