Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study

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Abstract

Background

The objective of this study was to evaluate the risk of benign peripheral persistent vertigo (BPPV) among patients with anxiety disorders by using the Taiwan National Health Insurance Research Database (NHIRD).

Methods

We conducted a retrospective study of 15,470 participants (7735 anxiety disorder patients and 7735 control patients) selected from the NHIRD. Patients were observed for a maximum of 9 years to determine the rates of newly diagnosed BPPV. A Cox regression model was used to evaluate the risk of BPPV among the patients with anxiety disorders.

Results

During the 9-year follow-up period, 178 (2.05 per 1000 person-years) anxiety disorder patients and 71 (0.81 per 1000 person-years) control patients were diagnosed with BPPV. The incidence risk ratio of BPPV between anxiety disorder patients and control patients was 2.52 (95 % confidence interval [CI], 1.90–3.37, P < .001). After adjustment for age, sex, and comorbidities, patients with anxiety disorders were found to be 2.17 times more likely to develop BPPV (95 % CI, 1.63–2.90, P < .001) than the control patients. Furthermore, female sex (HR = 1.81, 95 % CI, 1.31–2.50, P < .001) and cerebrovascular disease (HR = 1.53, 95 % CI, 1.00–2.34, P = .050) were independent risk factors for developing new-onset BPPV in patients with anxiety disorders.

Conclusions

Anxiety disorder patients may have an increased risk of developing BPPV, especially those who are female or have cerebrovascular disease.

Related collections

Most cited references 38

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To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

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In 1995, after a planning effort of about half a decade, the Republic of China (Taiwan) replaced a previous patchwork of separate social health insurance funds with one single-payer, national health insurance scheme that is administered by an agency of the central government's Department of Health. Within a year this bold legislative act brought the health care utilization rates of the 41 percent of Taiwan's hitherto uninsured population up to par with those of the previously insured population. This paper describes the achievements of this policy initiative so far, along with the growing pains it has encountered, and seeks to extract lessons from the experience for health policymakers in other countries.

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Author and article information

Contributors

Zi-Jun Chen: judychen8811@hotmail.com

Cheng-Ho Chang: kvjang58@gmail.com

Li-Yu Hu: chrishuly@gmail.com

Ming-Shium Tu: mstu@vghks.gov.tw

Ti Lu: tlu@vghks.gov.tw

Pan-Ming Chen: +886-3-9905106 , PMC461002@yahoo.com.tw

Cheng-Che Shen: +886-5-2359630 , pures1000@yahoo.com.tw

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 15 July 2016

Publication date PMC-release: 15 July 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 238

Affiliations

[ ]Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[ ]Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[ ]Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan

[ ]Department of Psychiatry, Yuanshan & Suao Branch, Taipei Veterans General Hospital, No. 301, Sec. 1, Subin Rd., Suao Township, Yilan County 27047 Taiwan

[ ]Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, No.600, Sec. 2, Shixian Rd., West District, Chiayi City, 60090 Taiwan

[ ]Department of information management, National Chung-Cheng University, Chiayi, Taiwan

Article

Publisher ID: 950

DOI: 10.1186/s12888-016-0950-2

PMC ID: 4946194

PubMed ID: 27416989

SO-VID: 1517bacf-fdbf-4713-b5ab-6dd6c9e291ce

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.