Incidence of peripheral vestibular disorders based on population data of South Korea

Abstract

BACKGROUND:

There have been no comprehensive studies on the incidence of peripheral vestibular disorders based on population-based data for a long-term period.

OBJECTIVE:

We investigated the incidence of peripheral vestibular disorders using population-based data representing the whole population of South Korea.

METHODS:

This study used the National Health Insurance Service data in Korea from 2008 to 2020. Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Meniere’s disease (MD) were defined with diagnostic, treatment, or audiovestibular test codes. The annual incidence in total and according to sex, age, and residence was analyzed.

RESULTS:

The annual incidence of BPPV, VN, and MD per 100,000 was 51.4, 22.7, and 12.4 in 2008 and 181.1, 62.9, and 50.5 in 2020, respectively. The incidence of each was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001), with the highest value in female, people aged 60 years or older, and people who resided in metropolitan cities.

CONCLUSIONS:

The annual incidence of BPPV, VN, and MD had increasing trends from 2008 through 2020 in South Korea, and all were significantly higher in female, people aged 60 years or older, and people who resided in metropolitan cities.

Keywords

Incidence peripheral vestibular disorder peripheral vertigo benign paroxysmal positional vertigo vestibular neuritis Meniere’s disease population-based study

1 Introduction

Symptoms of dizziness, vertigo, and imbalance are some of the most common symptoms leading to a hospital visit. These symptoms can be associated with various etiologies such as stroke of cerebellum and brain stem, cardiovascular disease, psychiatric disorders, and, in particular, peripheral vestibular disorders [7 , 18]. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness and vertigo in a study of a referral-based dizziness clinic in South Korea [10].

BPPV, vestibular neuritis (VN), and Meniere’s disease (MD) are the most common and important peripheral vestibular disorders [14]. The prevalence of BPPV has been reported to range from 10.7 to 140 per 100,000 [4], and lifetime prevalence has been reported to be 2.4% with an annual incidence of 0.6% [4 , 17]. The annual incidence of VN has been reported to be from 3.5 to 15.5 per 100,000 [1 , 16]. The prevalence of MD has been reported to be 190 per 100,000 in the United States [3, 6], whereas the average annual incidence and prevalence have been reported to be 5.0 and 34.5, respectively, per 100,000 in Japan [15].

Global society is becoming aging or aged. Korea is aged society characterized by a 14% or larger proportion of the population aged 65 years or more and is expected to become a super-aged society in which the proportion of population aged 65 years or more is 20 percent or more in 2025. The prevalence of dizziness was reported to increase with age in a population-based study in Korea [5]. The incidence of peripheral vestibular disorders also could change over time with society aging in Korea. Despite this situation, there have been no comprehensive studies on the incidence based on population-based data of the whole population for a long-term period. In this study, we investigated the incidence of peripheral vestibular disorders using population-based data representing the whole population of South Korea.

2 Materials and methods

2.1 Subjects

This study used the National Health Insurance Service data comprising the whole population of Korea from 2008 to 2020. All Korean people are required to join the National Health Insurance Service. Thus, results from this study are representative of the whole population of the country. Peripheral vestibular disorders such as BPPV, VN, and MD were defined with diagnostic codes of the International Classification of Diseases (ICD); treatment code for canalolith repositioning maneuver; audiometric test codes including pure tone audiometry, speech audiometry, auditory brainstem response, and auditory steady-state response; or vestibular function test codes including nystagmus test and caloric test. Patients who underwent canalolith repositioning maneuver under the diagnosis of BPPV (H81.1 in the ICD) were defined as patients with BPPV. Patients who underwent vestibular function tests once or more at admission or at the outpatient department with re-visit within one month once or more under the diagnosis of VN (H81.2 in the ICD) were defined as patients with VN. Patients who underwent both audiometric and vestibular function tests once or more at admission or at the outpatient department with re-visit within one month once or more under the diagnosis of MD (H81.0 in the ICD) were defined as patients with MD. New-onset peripheral vestibular disorders that occurred during the study period were included in the present study. Patients were grouped according to sex, 20-year age range, and residence.

The Institutional Review Board of the authors’ institution approved this study (NHIMC 2022-02-012). Written informed consent was exempted given the retrospective nature of the study.

2.2 Data analysis

The annual incidence of peripheral vestibular disorders in total and according to sex, age, and residence from 2008 to 2020 was analyzed using the numbers of patients with the disease and in the population, respectively. The differences in the incidence of peripheral vestibular disorders among sex, age, and residence were analyzed using the Chi-square test. Statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, NC, USA).

3 Results

The number of new onset patients with BPPV was 25,439 in 2008 and 179,572 in 2020. Patients with BPPV were mostly female, aged 40–59 years, and resided in medium and small cities and rural areas (Table 1). The annual incidence of BPPV per 100,000 was 51.4 in 2008 and 181.1 in 2020, with the highest values in female, people aged 60 years or older, and people who resided in metropolitan cities. There was an increasing trend in the annual incidence of BPPV. The incidence of BPPV was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001) (Fig. 1).

Table 1
The number of new onset patients with benign paroxysmal positional vertigo in Korea

Year Sex Age (year) Residence

Male Female – 19 20– 39 40– 59 60– Seoul (capital) Metropolitan Medium and Total

cities small cities

and rural areas

N % N % N % N % N % N % N % N % N %

2008 7,482 29.4 17,957 70.6 454 1.8 4,362 17.1 11,523 45.3 9,100 35.8 5,201 20.4 8,868 34.9 11,370 44.7 25,439

2009 10,267 29.9 24,054 70.1 631 1.8 5,765 16.8 15,134 44.1 12,791 37.3 6,492 18.9 12,056 35.1 15,773 46.0 34,321

2010 13,727 30.5 31,240 69.5 786 1.7 7,380 16.4 19,640 43.7 17,161 38.2 8,277 18.4 16,149 35.9 20,541 45.7 44,967

2011 16,974 30.2 39,186 69.8 1,082 1.9 9,365 16.7 24,773 44.1 20,940 37.3 10,605 18.9 18,061 32.2 27,494 49.0 56,160

2012 20,854 29.8 49,031 70.2 1,320 1.9 11,656 16.7 30,327 43.4 26,582 38.0 13,804 19.8 20,895 29.9 35,186 50.3 69,885

2013 23,310 29.9 54,700 70.1 1,467 1.9 12,934 16.6 33,564 43.0 30,045 38.5 15,481 19.8 22,375 28.7 40,154 51.5 78,010

2014 26,331 30.1 61,174 69.9 1,701 1.9 14,860 17.0 37,594 43.0 33,350 38.1 17,124 19.6 24,860 28.4 45,521 52.0 87,505

2015 30,809 30.5 70,350 69.5 1,927 1.9 17,488 17.3 43,064 42.6 38,680 38.2 19,813 19.6 28,888 28.6 52,458 51.9 101,159

2016 34,397 30.0 80,268 70.0 2,207 1.9 20,510 17.9 48,509 42.3 43,439 37.9 21,950 19.1 32,247 28.1 60,468 52.7 114,665

2017 38,070 30.3 87,479 69.7 2,233 1.8 21,841 17.4 52,220 41.6 49,255 39.2 23,497 18.7 34,935 27.8 67,117 53.5 125,549

2018 41,781 30.2 96,460 69.8 2,488 1.8 23,806 17.2 56,512 40.9 55,435 40.1 24,818 18.0 38,016 27.5 75,407 54.5 138,241

2019 48,051 30.8 107,802 69.2 2,920 1.9 27,491 17.6 62,696 40.2 62,746 40.3 27,753 17.8 43,909 28.2 84,191 54.0 155,853

2020 55,947 31.2 123,625 68.8 3,341 1.9 34,465 19.2 71,485 39.8 70,281 39.1 32,359 18.0 49,535 27.6 97,678 54.4 179,572

Total 368,000 30.4 843,326 69.6 22,557 1.9 211,923 17.5 507,041 41.9 469,805 38.8 227,174 18.8 350,794 29.0 633,358 52.3 1,211,326

Year	Sex	Age (year)	Residence
2008	7,482	29.4	17,957	70.6	454	1.8	4,362	17.1	11,523	45.3	9,100	35.8	5,201	20.4	8,868	34.9	11,370	44.7	25,439
2009	10,267	29.9	24,054	70.1	631	1.8	5,765	16.8	15,134	44.1	12,791	37.3	6,492	18.9	12,056	35.1	15,773	46.0	34,321
2010	13,727	30.5	31,240	69.5	786	1.7	7,380	16.4	19,640	43.7	17,161	38.2	8,277	18.4	16,149	35.9	20,541	45.7	44,967
2011	16,974	30.2	39,186	69.8	1,082	1.9	9,365	16.7	24,773	44.1	20,940	37.3	10,605	18.9	18,061	32.2	27,494	49.0	56,160
2012	20,854	29.8	49,031	70.2	1,320	1.9	11,656	16.7	30,327	43.4	26,582	38.0	13,804	19.8	20,895	29.9	35,186	50.3	69,885
2013	23,310	29.9	54,700	70.1	1,467	1.9	12,934	16.6	33,564	43.0	30,045	38.5	15,481	19.8	22,375	28.7	40,154	51.5	78,010
2014	26,331	30.1	61,174	69.9	1,701	1.9	14,860	17.0	37,594	43.0	33,350	38.1	17,124	19.6	24,860	28.4	45,521	52.0	87,505
2015	30,809	30.5	70,350	69.5	1,927	1.9	17,488	17.3	43,064	42.6	38,680	38.2	19,813	19.6	28,888	28.6	52,458	51.9	101,159
2016	34,397	30.0	80,268	70.0	2,207	1.9	20,510	17.9	48,509	42.3	43,439	37.9	21,950	19.1	32,247	28.1	60,468	52.7	114,665
2017	38,070	30.3	87,479	69.7	2,233	1.8	21,841	17.4	52,220	41.6	49,255	39.2	23,497	18.7	34,935	27.8	67,117	53.5	125,549
2018	41,781	30.2	96,460	69.8	2,488	1.8	23,806	17.2	56,512	40.9	55,435	40.1	24,818	18.0	38,016	27.5	75,407	54.5	138,241
2019	48,051	30.8	107,802	69.2	2,920	1.9	27,491	17.6	62,696	40.2	62,746	40.3	27,753	17.8	43,909	28.2	84,191	54.0	155,853
2020	55,947	31.2	123,625	68.8	3,341	1.9	34,465	19.2	71,485	39.8	70,281	39.1	32,359	18.0	49,535	27.6	97,678	54.4	179,572
Total	368,000	30.4	843,326	69.6	22,557	1.9	211,923	17.5	507,041	41.9	469,805	38.8	227,174	18.8	350,794	29.0	633,358	52.3	1,211,326

Fig. 1

Annual incidence of benign paroxysmal positional vertigo in Korea in total and according to sex (A), age (year) (B), and residence (C).

The number of new onset patients with VN was 11,223 in 2008 and 32,611 in 2020. Patients with VN were mostly female, aged 40–59 years, and resided in medium and small cities and rural areas (Table 2). The annual incidence of VN per 100,000 was 22.7 in 2008 and 62.9 in 2020, with the highest values in female, people aged 60 years or older, and people who resided in metropolitan cities. There was an increasing trend in the annual incidence of VN. The incidence of VN was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001) (Fig. 2).

Table 2

The number of new onset patients with vestibular neuritis in Korea

Year	Sex				Age (year)								Residence
	Male		Female		– 19		20– 39		40– 59		60–		Seoul (capital)		Metropolitan		Medium and		Total
															cities		small cities
																	and rural areas
	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
2008	4,054	36.1	7,169	63.9	228	2.0	1,703	15.2	4,792	42.7	4,500	40.1	1,753	15.6	3,918	34.9	5,552	49.5	11,223
2009	4,694	36.1	8,326	63.9	340	2.6	2,125	16.3	5,397	41.5	5,158	39.6	1,954	15.0	4,452	34.2	6,614	50.8	13,020
2010	4,525	34.8	8,482	65.2	311	2.4	2,013	15.5	5,603	43.1	5,080	39.1	1,982	15.2	4,431	34.1	6,594	50.7	13,007
2011	4,984	34.8	9,319	65.2	320	2.2	2,227	15.6	6,359	44.5	5,397	37.7	2,256	15.8	4,675	32.7	7,372	51.5	14,303
2012	6,210	34.3	11,907	65.7	469	2.6	2,945	16.3	7,865	43.4	6,838	37.7	2,929	16.2	6,157	34.0	9,031	49.8	18,117
2013	6,704	35.1	12,397	64.9	463	2.4	2,861	15.0	8,395	44.0	7,382	38.6	3,199	16.7	6,436	33.7	9,466	49.6	19,101
2014	7,475	36.2	13,163	63.8	468	2.3	3,096	15.0	8,880	43.0	8,194	39.7	3,180	15.4	6,725	32.6	10,733	52.0	20,638
2015	8,196	36.3	14,373	63.7	505	2.2	3,470	15.4	9,665	42.8	8,929	39.6	3,409	15.1	6,926	30.7	12,234	54.2	22,569
2016	8,937	36.2	15,781	63.8	532	2.2	3,717	15.0	10,480	42.4	9,989	40.4	3,736	15.1	7,625	30.8	13,357	54.0	24,718
2017	9,681	36.4	16,928	63.6	554	2.1	4,002	15.0	11,112	41.8	10,941	41.1	4,148	15.6	8,248	31.0	14,213	53.4	26,609
2018	10,766	36.6	18,630	63.4	560	1.9	4,128	14.0	11,930	40.6	12,778	43.5	4,265	14.5	8,898	30.3	16,233	55.2	29,396
2019	11,134	36.5	19,390	63.5	576	1.9	4,188	13.7	11,919	39.0	13,841	45.3	4,254	13.9	9,506	31.1	16,764	54.9	30,524
2020	11,906	36.5	20,705	63.5	643	2.0	5,020	15.4	12,766	39.1	14,182	43.5	4,744	14.5	9,998	30.7	17,869	54.8	32,611
Total	99,266	36.0	176,570	64.0	5,969	2.2	41,495	15.0	115,163	41.8	113,209	41.0	41,809	15.2	87,995	31.9	146,032	52.9	275,836

Fig. 2

Annual incidence of vestibular neuritis in Korea in total and according to sex (A), age (year) (B), and residence (C).

The number of new onset patients with MD was 6,154 in 2008 and 26,199 in 2020. Patients with MD were mostly female, aged 40–59 years, and resided in medium and small cities and rural areas (Table 3). The annual incidence of MD per 100,000 was 12.4 in 2008 and 50.5 in 2020, with the highest values in female, people aged 60 years or older, and people who resided in metropolitan cities. There was an increasing trend in the annual incidence of MD. The incidence of MD was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001) (Fig. 3).

Table 3

The number of new onset patients with Meniere’s disease in Korea

Year	Sex				Age (year)								Residence
	Male		Female		– 19		20– 39		40– 59		60–		Seoul (capital)		Metropolitan		Medium and		Total
															cities		small cities
																	and rural areas
	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
2008	1,681	27.3	4,473	72.7	177	2.9	1,327	21.6	2,665	43.3	1,985	32.3	1,506	24.5	1,555	25.3	3,093	50.3	6,154
2009	2,069	27.2	5,525	72.8	239	3.1	1,539	20.3	3,222	42.4	2,594	34.2	1,651	21.7	2,204	29.0	3,739	49.2	7,594
2010	2,426	28.5	6,083	71.5	226	2.7	1,512	17.8	3,630	42.7	3,141	36.9	1,611	18.9	2,901	34.1	3,997	47.0	8,509
2011	3,172	28.1	8,105	71.9	381	3.4	2,091	18.5	4,799	42.6	4,006	35.5	2,050	18.2	4,001	35.5	5,226	46.3	11,277
2012	4,175	28.4	10,529	71.6	458	3.1	2,577	17.5	6,329	43.0	5,340	36.3	2,665	18.1	4,876	33.2	7,163	48.7	14,704
2013	4,395	28.7	10,926	71.3	480	3.1	2,603	17.0	6,504	42.5	5,734	37.4	2,596	16.9	5,203	34.0	7,522	49.1	15,321
2014	4,485	28.6	11,195	71.4	497	3.2	2,587	16.5	6,743	43.0	5,853	37.3	2,563	16.3	5,446	34.7	7,671	48.9	15,680
2015	5,205	28.8	12,871	71.2	553	3.1	2,980	16.5	7,604	42.1	6,939	38.4	3,002	16.6	6,263	34.6	8,811	48.7	18,076
2016	5,901	28.9	14,505	71.1	625	3.1	3,645	17.9	8,370	41.0	7,766	38.1	3,120	15.3	6,725	33.0	10,561	51.8	20,406
2017	6,503	29.2	15,766	70.8	645	2.9	3,769	16.9	9,025	40.5	8,830	39.7	3,455	15.5	6,922	31.1	11,892	53.4	22,269
2018	7,369	29.8	17,319	70.2	610	2.5	4,110	16.6	9,842	39.9	10,126	41.0	3,745	15.2	7,435	30.1	13,508	54.7	24,688
2019	7,595	29.9	17,789	70.1	565	2.2	4,070	16.0	9,836	38.7	10,913	43.0	4,117	16.2	7,457	29.4	13,810	54.4	25,384
2020	8,005	30.6	18,194	69.4	624	2.4	4,503	17.2	9,958	38.0	11,114	42.4	4,417	16.9	7,285	27.8	14,497	55.3	26,199
Total	62,981	29.1	153,280	70.9	6,080	2.8	37,313	17.3	88,527	40.9	84,341	39.0	36,498	16.9	68,273	31.6	111,490	51.6	216,261

Fig. 3

Annual incidence of Meniere’s disease in Korea in total and according to sex (A), age (year) (B), and residence (C).

4 Discussion

There have been several studies recently on the prevalence and distribution of peripheral vestibular disorders including BPPV, VN, and MD according to sex, age, and residence using population-based data [7, 18]. However, there have been no studies analyzing the incidence over a long-term period of more than 10 years. Considering the change of the composition of sex and age in the whole population over time, investigations into the change of the annual incidence of peripheral vestibular disorders and the difference in the incidence according to demographic factors are necessary.

Recently, Hülse et al. reported that the prevalence of BPPV, VN, and MD was 458, 162, and 205 per 100,000, respectively, in 2015 in Germany [7]. Yang et al. reported that the prevalence of BPPV, VN, and MD was 446.4, 307.2, and 70.4 per 100,000, respectively, in 2016 in Taiwan [18]. However, the annual incidence of BPPV and VN based on population-based study has not been reported recently. For MD, Kim and Cheon reported that the prevalence and incidence of MD were 152.76 and 118.48 per 100,000, respectively, in 2017 in Korea [11]. The annual incidence in the present study was lower than that in Kim and Cheon’s study based on the National Health Insurance Claims Database, which was similar to the database in the present study. This might be attributable to the stricter definition of MD based on both audiometric and vestibular function tests and at least two visits at the outpatient department in the present study.

In the present study, the annual incidence of BPPV, VN, and MD showed increasing trends. Kim and Cheon’s study also showed a rapid increase of incidence of MD annually from 2013 to 2017 [11]. The increase in the incidence of peripheral vestibular disorders is possibly due to the increase of aged people considering that the incidence was highest in people aged 60 years or older in the present study. The proportion of people aged 60 years or older in Korea is increasing, as shown in Table 4. Age-related changes in hormones, various extrinsic factors, and increased oxidative stress can result in apoptosis of the inner ear hair cells [10]. In Hülse et al. and Yang et al.’s studies, the prevalence of BPPV, VN, and MD increased with age [7, 18], in agreement with the present study. Decrease in vestibular function and vision, polyneuropathies, polypharmacy, osteoporosis, and musculoskeletal weakness in aged people could be the cause of the increase of peripheral vestibular disorders [7, 18]. In addition, the improvement of diagnostic accuracy might have influenced the increasing trends in the incidence of peripheral vestibular disorders.

Table 4
The population according to the 20-year age range in Korea

Age (year) –19 20–39 40–59 60– Total

Year N % N % N % N %

2008 11,921,785 24.1 15,695,932 31.7 14,812,421 29.9 7,110,229 14.4 49,540,367

2009 11,734,619 23.6 15,399,795 30.9 15,237,572 30.6 7,401,159 14.9 49,773,145

2010 11,584,399 22.9 15,237,505 30.2 15,911,175 31.5 7,782,587 15.4 50,515,666

2011 11,356,974 22.4 14,982,202 29.5 16,374,829 32.3 8,020,279 15.8 50,734,284

2012 11,115,990 21.8 14,795,891 29.0 16,627,728 32.6 8,408,663 16.5 50,948,272

2013 10,853,649 21.2 14,604,943 28.6 16,945,217 33.1 8,737,654 17.1 51,141,463

2014 10,580,278 20.6 14,453,891 28.2 17,146,377 33.4 9,147,370 17.8 51,327,916

2015 10,318,777 20.0 14,370,014 27.9 17,183,784 33.3 9,656,763 18.7 51,529,338

2016 10,047,206 19.4 14,292,568 27.6 17,221,714 33.3 10,134,728 19.6 51,696,216

2017 9,739,623 18.8 14,179,616 27.4 17,192,956 33.2 10,666,349 20.6 51,778,544

2018 9,434,215 18.2 14,094,116 27.2 17,104,471 33.0 11,193,257 21.6 51,826,059

2019 9,125,924 17.6 13,881,380 26.8 17,050,607 32.9 11,791,950 22.7 51,849,861

2020 8,763,406 16.9 13,679,270 26.4 16,939,801 32.7 12,446,546 24.0 51,829,023

Age (year)	–19	20–39	40–59	60–	Total
2008	11,921,785	24.1	15,695,932	31.7	14,812,421	29.9	7,110,229	14.4	49,540,367
2009	11,734,619	23.6	15,399,795	30.9	15,237,572	30.6	7,401,159	14.9	49,773,145
2010	11,584,399	22.9	15,237,505	30.2	15,911,175	31.5	7,782,587	15.4	50,515,666
2011	11,356,974	22.4	14,982,202	29.5	16,374,829	32.3	8,020,279	15.8	50,734,284
2012	11,115,990	21.8	14,795,891	29.0	16,627,728	32.6	8,408,663	16.5	50,948,272
2013	10,853,649	21.2	14,604,943	28.6	16,945,217	33.1	8,737,654	17.1	51,141,463
2014	10,580,278	20.6	14,453,891	28.2	17,146,377	33.4	9,147,370	17.8	51,327,916
2015	10,318,777	20.0	14,370,014	27.9	17,183,784	33.3	9,656,763	18.7	51,529,338
2016	10,047,206	19.4	14,292,568	27.6	17,221,714	33.3	10,134,728	19.6	51,696,216
2017	9,739,623	18.8	14,179,616	27.4	17,192,956	33.2	10,666,349	20.6	51,778,544
2018	9,434,215	18.2	14,094,116	27.2	17,104,471	33.0	11,193,257	21.6	51,826,059
2019	9,125,924	17.6	13,881,380	26.8	17,050,607	32.9	11,791,950	22.7	51,849,861
2020	8,763,406	16.9	13,679,270	26.4	16,939,801	32.7	12,446,546	24.0	51,829,023

BPPV is more common in older people [4], and has been reported to have a possible association with osteoporosis or osteopenia [2, 4]. Comorbidities such as hypertension and diabetes in the elderly could influence BPPV [2]. Considering these, the incidence can increase with age. VN is thought to be caused by reactivation of latent type 1 herpes simplex virus infection, autoimmunity, or microvascular ischemia [9]. These etiologic factors could have greater influence on the elderly, who are more immunocompromised and have more insufficient microvascular circulation than younger people. The number of patients with elderly-onset MD was reported to increase in a previous study in Japan, which was explained by a larger number of working elderly people and subsequent job-related mental and physiologic fatigue [15]. Similarly, the incidence of MD increased up to the age of 70 s in a previous population-based study in Korea [11].

The incidence of peripheral vestibular disorders was higher in females than in males in the present study. Previous population-based studies also revealed higher incidence or prevalence of BPPV, VN, and MD in females than in males [6 , 18]. Higher incidence of BPPV in female might be attributed to hormonal fluctuations during menopause and higher incidence of osteoporosis in women, considering that osteoporosis and osteopenia were reported to be associated with BPPV [7, 18]. In addition, the higher incidence of peripheral vestibular disorders in women can be associated with anxiety, which is more common in females [18]. VN appears with acute severe vestibular symptoms, which could induce anxiety. Thus, female patients with VN might visit the hospital more frequently, resulting in higher incidence of VN. However, considering the many possible causes of VN, the higher incidence of VN in females cannot be explained by anxiety alone, and needs further investigation. For MD, hormonal influences and health-seeking behaviors in women might be the cause of higher incidence [11].

In the present study, the incidence of BPPV, VN, and MD was all highest in people who resided in metropolitan cities. However, the difference according to residence should be interpreted carefully. In a Taiwanese population-based study, rural residence was associated with BPPV and MD. Stimuli such as moving vehicles and disorienting lights and noise, lack of physical activity, and chronic stress in urban area could induce vertigo [18]. MD was reported to be associated with air pollutants, and the association was stronger in urban areas [12]. Lower atmospheric pressure and high humidity were reported to be associated with symptom exacerbation in MD [13]. Several studies reported that solar insolation, serum vitamin D level, and BPPV might be related [8], so difference in solar insolation according to residence should be considered. Access to medical institutions specializing in peripheral vestibular disorders is typically better in metropolitan cities than in smaller cities and rural areas. Thus, differences in the composition of sex and age in the population, environmental and meteorologic factors, and accessibility to medical institution among regions should be considered in the analysis of the difference in the incidence according to residence. The residence could not be divided into urban and rural areas strictly, and the association between the incidence and residence was unclear in the present study, which needs further investigation.

This study has several limitations. First, the incidence was analyzed using diagnostic codes and treatment or audiovestibular test codes and might not reflect the real incidence. Second, age was categorized into four groups only, and other confounding factors in the analysis of the incidence according to residence were not considered. This study aimed to investigate the incidence of peripheral vestibular disorders and the change of that over a long-term period. Despite these limitations, the incidence of peripheral vestibular disorders was verified according to demographic factors using the whole population database, and the change of the incidence was identified for a long-term period of 13 years in this study.

5 Conclusion

The annual incidence of peripheral vestibular disorders such as BPPV, VN, and MD all showed an increasing trend from 2008 through 2020 in South Korea. The annual incidence of BPPV, VN, and MD was all significantly higher in female, people aged 60 years or older, and people who resided in metropolitan cities.

Funding

This study was funded by a National Health Insurance Service Ilsan Hospital Grant (NHIMC 2021-20-013). The study used a National Health Insurance Service dataset (NHIS-2022-1-325) made available by the National Health Insurance Service of Korea.

Conflict of interest

The authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Institutional Review Board of the authors’ institution approved this study (NHIMC 2022-02-012). The requirement for written informed consent was waived by the Institutional Review Board of the authors’ institution due to the retrospective nature of the study.

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