Date of Completion


Embargo Period



Richard Stevens, Kourosh Parham, Joseph Burleson

Field of Study

Public Health


Master of Public Health

Open Access

Campus Access


Background: Vestibular dysfunction is a growing public health concern due to high prevalence in the geriatric population and the fact that it increases propensity for falls, leading to higher rates of morbidity, mortality and health care expenditure. The objective of this study was to determine the possible associations with vestibular dysfunction and other conditions that have been suggested in the literature such as low vitamin D serum levels, sedentary physical activity levels and low bone density in a population level database.

Methods: Data from the 2003-2004 National Health and Nutritional Examination Surveys (NHANES) of adults aged 40 years old and older was analyzed (n = 4,743). Vestibular dysfunction was defined by using Condition 4 of a modified Rhomberg balance test that was used during NHANES data collection. Condition 4 involved participants tasked with standing with their feet together for 30 seconds with eyes closed on a firm and compliant support surface to reduce the sensory input of both vision and proprioception. Those participants that were able to stand for 30 seconds passed the balance test and those that either opened their eyes or moved their feet in order to regain balance failed and we defined them as having “vestibular dysfunction”.

Results: Rates of vestibular dysfunction increased with age for both males (37.5% vs. 68.7%) and females (36.1% vs. 69.9%) when comparing those under and over the median age, respectively. Vitamin D serum levels appeared to not have a statistically significant association with changing rates of vestibular dysfunction in any subset analysis, however trends of reducing rates of vestibular dysfunction as vitamin D levels increased existed in both females and males above the median age. Females with osteopenia had a 40% increased rate of vestibular dysfunction when compared to females with normal bone density (59.5% vs.83.7%, p < 0.001). Those participants with at least some college education appeared to have a 50% reduction in rates of vestibular dysfunction (OR = 0.485, p < 0.001), while those with diabetes had a 23% increase in rates of vestibular dysfunction (55.4% vs. 68.5%, p <0.001).

Conclusions: The results of this study suggest the importance of continued research into the possible association between low levels of vitamin D and reduced bone mineral density with increased rates of vestibular dysfunction. Targeted fall risk analysis of those people with conditions that appear to be associated with higher rates of vestibular dysfunction such as those with diabetes, low bone mineral density and low level of formal education, may improve the detection rate of vestibular dysfunction prior to dangerous falls.

Major Advisor

Richard Stevens