Balance Disorder Tied to All-Cause Mortality Risk

By Lisa Rapaport

March 22, 2021

(Reuters Health) - Individuals with balance disorder are at increased risk of premature death from all causes as well as from cardiovascular disease and cancer, a U.S. study in JAMA Otolaryngology-Head & Neck Surgery suggests.

Researchers examined data on 5,816 adult participants (mean age 53.6) from the U.S. National Health and Nutrition Examination Study who had completed balance assessments with a modified Romberg Test of Standing Balance on Firm and Compliant Surfaces. Overall, 2,509 participants had balance disorder at baseline.

After a median follow-up of 12.5 years, a total of 1,520 people died, including 342 fatalities associated with cardiovascular disease and 364 linked to cancer.

Compared to participants without balance disorder, those with balance disorder were significantly more likely to die from all causes (hazard ratio 1.44), cardiovascular disease (HR 1.65), and cancer (HR 1.37), after adjustment for sociodemographic characteristics, lifestyle factors, and chronic conditions.

"Our findings suggest that balance function can be an indicator/marker of long-term health outcomes and mortality risks," said lead study author Chao Cao of the program in physical therapy at Washington University School of Medicine in St. Louis.

"From a clinical practice perspective, the screening of sensory-specific balance function should be implemented in not only older adults but also middle-aged adults and individuals with high risks of balance disorders, such as patients with chronic diseases," Cao said by email.

Screening earlier in adulthood may help identify patients who might benefit from interventions designed to manage and potentially improve balance function, such as multicomponent exercise programs or holistic exercises such as Tai Chi, Cao added.

Balance disorder became more common with advancing age, affecting 18.2% of adults 40 to 49 years old, 33.5% aged 50 to 64, and 61.9% of those 65 and older. People were more likely to have balance disorder when they had lower income and education levels, less physical activity, and chronic diseases.

Vestibular balance disorder, in particular, was associated with a significantly increased risk of all-cause mortality (HR 1.31), as well as mortality from cardiovascular disease (HR 1.59) and cancer (HR 1.39).

One limitation of the study is that sensory balance disorders were not assessed with diagnostic instruments. The study also wasn't designed to determine a causal relationship between balance and mortality.

"Balance impairments may be caused by subclinical vascular and metabolic diseases, such as diabetes and metabolic syndrome, which in turn are important risk factors for cardiovascular disease and several cancers," said Dr. Marco Pahor, director of the University of Florida Institute on Aging at the University of Florida Academic Health Center, in Gainesville.

It's possible that because the study relied on self-reported data on any chronic medical conditions, some participants may have had subclinical or undiagnosed diseases, Dr. Pahor, who wasn't involved in the study, said by email.

Even so, the study suggests that clinicians should be routinely assessing balance as a potential indicator of emerging disease, Dr. Pahor said.

"A simple balance test which can be easily performed in a doctor's office can prompt physicians to screen for subclinical vascular and metabolic diseases, and counsel patients for more aggressive cardiovascular and cancer prevention," Dr. Pahor said.

SOURCE: JAMA Otolaryngology-Head & Neck Surgery, online March 11, 2021.