Dizziness and Balance-Related Symptom Burden and 12-Month Fall Risk in U.S. Adults Aged 20 to 69 Years

This is the authors' abstract. We don't add key points for this paper.

Importance: Falls are often viewed as a problem of older age, yet dizziness and balance-related symptoms are common in adulthood and may help identify adults with elevated fall burden. Objective: To examine associations of dizziness and balance-related symptom burden with 12-month fall outcomes in U.S. adults aged 20 to 69 years and whether objective balance impairment adds information beyond symptoms. Design: Cross-sectional study. Setting: National Health and Nutrition Examination Survey 2021 to 2023. Participants: The primary cohort included 6000 adults aged 20 to 69 years with complete symptom and outcome data. Extension analyses included participants with complete Modified Romberg Test data. Intervention or Exposures: Self-reported dizziness/balance-related symptoms in the past 12 months: vertigo, blurred vision with head movement, unsteadiness, and light-headedness/fainting. Secondary exposures were symptom count and objective balance impairment. Main Outcome Measures: Any fall, recurrent falls (≥3), frequent falls (≥5), and fall-related injury in the past 12 months. Survey-weighted quasi-Poisson regression estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: The weighted prevalence of any dizziness/balance-related symptom was 32.7%. After full adjustment, any symptom was associated with any fall (PR, 1.57; 95% CI, 1.40-1.75), recurrent falls (PR, 3.44; 95% CI, 2.81-4.21), frequent falls (PR, 5.09; 95% CI, 3.64-7.13), and fall-related injury (PR, 2.10; 95% CI, 1.66-2.65). Symptom count showed a dose-response relationship across outcomes. Compared with no symptoms, reporting 3 or more symptoms was associated with PRs of 1.97, 5.24, 8.19, and 3.10, respectively. Objective balance impairment alone showed weaker associations, whereas joint symptom-impairment phenotypes better stratified fall burden. Conclusions: Dizziness and balance-related symptom burden were strongly associated with multiple 12-month fall outcomes in U.S. adults aged 20 to 69 years. Objective balance impairment added limited complementary information beyond symptoms. Relevance: Symptom-based assessment may be a practical first step, with objective balance testing used selectively.