Dizziness Linked to Mortality Risk for Diabetes, Cardiovascular Disease, Cancer

Matthew E. Lin, BS

Credit: LinkedIn

A new study found symptomatic dizziness was linked to an increased risk for cause-specific mortality from diabetes, cardiovascular disease, and cancer—but not unintentional injuries.¹

“While the association between symptomatic dizziness and cardiovascular disease–related mortality in this study is in line with findings from previous studies using objective balance tests, we also found an association between symptomatic dizziness and diabetes-specific mortality not previously reported,” wrote investigators, led by Matthew E. Lin, BS, from the Keck School of Medicine of the University of Southern California in Los Angeles.

Many people complain about dizziness, and it is considered the most common health complaint in the general population. Dizziness has a prevalence of 15% – 36% and is linked to an increased risk for falls, health care visits, hospital admissions, and disability. About 2.8 million emergency department visits annually are because of dizziness.

Dizziness can be caused by many things—inner ear problems, reduced blow flow such as a stroke, particular medications, and psychiatric conditions such as major depressive disorder or generalized anxiety disorder.² Yet sometimes people have nonspecific symptomatic dizziness, and people may experience vertigo or lightheadedness.¹

Since dizziness can lead to death, investigators sought to find out if symptomatic dizziness are associated with all-cause and cause-specific mortality.

They conducted a follow-up study of a cross-sectional cohort based on NHANES, leveraging data from the 1999 – 2004 National Health and Nutrition Examination Survey. Respondents, aged ≥ 40 years, answered questions about symptomatic dizziness, such as issues with dizziness, balance, falling, and positional dizziness, within the past 12 months. The survey did not characterize dizziness in separate terms, so respondents could not report “room-spinning sensations, lightheadedness, and disequilibrium.”

Additionally, investigators looked at mortality data through December 31, 2019. The team assessed for all-cause and cause-specific mortality. The specific causes examined were cardiovascular disease, diabetes, cancer, and unintentional injuries. They analyzed the data from February to August 2023.

The cohort had 9000 middle-aged and older US adults with a mean age of 61.8 and 50.8% female. There was a 23.8% prevalence of symptomatic dizziness, with 18.3% reporting subjective dizziness, 14.5% reporting issues with balance, 5.7% reporting issues with falling, and 3.8% reported dizziness when turning in bed (positional dizziness). Of the respondents who reported symptomatic dizziness, 65.1% reported issues with balance or falling.

The follow-up period, approximately 16.2 years later with a range of 0.1 – 20.6 years, was either at the date of death or at the end of the mortality period (December 31, 2019). At the follow-up, all-cause mortality for adults with symptomatic dizziness (45.6%) was greater than those without (27.1%). Mortality rates among respondents reporting falls, balance, dizziness, and positional dizziness were 61.7%, 51%, 41.3%, and 38.5%, respectively.

Using Cox proportional hazard models, investigators found symptomatic dizziness was linked to an increase in cause-mortality from diabetes (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.23 – 2.25), cardiovascular disease (HR, 1.33; 95% CI, 1.12 – 1.55), and cancer (HR, 1.21; 95% CI, 0.99 – 1.47). However, there was not an increased risk for unintentional injuries (HR, 0.98; 95% CI, 0.51 – 1.88).

Balance (HR, 1.27; 95% CI, 1.17 – 1.39) and falling (HR, 1.52; 95% CI, 1.33 – 1.73) were linked to an increased risk of all-cause mortality. They were also associated with cause-specific mortality from cardiovascular disease (balance: HR, 1.41; 95% CI, 1.20 – 1.66; falling: HR, 1.49; 95% CI, 1.15 – 1.94) and diabetes (balance: HR, 1.74; 95% CI, 1.26 – 2.39; falling: HR, 2.01; 95% CI, 1.26 – 3.18). The team observed no link between positional dizziness and mortality (HR, 0.98; 95% CI, 0.82 – 1.19).

Limitations the investigators highlighted were using self-reported data on dizzy symptoms, not having data of dizziness onset or change in status of symptomatic dizziness available, the number of unintentional injuries being relatively small which could have affected the lack of associations, using observational data and thus not being able to determine casual relationships, and survey questions lacking characterization of dizziness such as lightheadedness.

“As the US population continues to age, patients presenting with symptomatic dizziness will continue to increase in prevalence,” investigators concluded. “Identifying interventions that effectively manage dizziness and their effect on mortality represent important areas of future work.”

^References

1. ^{Lin, M. Gallagher, T, Straughan, A. Association of Symptomatic Dizziness with All-Cause and Cause-Specific Mortality. JAMA Otolaryngol Head Neck Surg. 2024. doi:10.1001/jamaoto.2023.4554}
2. ^{Dizziness. Mayo Clinic. https://www.mayoclinic.org/symptoms/dizziness/basics/causes/sym-20050886. Accessed February 8, 2024.}