title: Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  Anxiety disorder patients may have an increased risk of developing BPPV, especially those who are female or have cerebrovascular disease.
authors.affiliation: Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Zi-Jun
authors.initials: ZJ
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Cheng-Ho
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.affiliation: Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Shium
authors.initials: MS
authors.lastname: Tu
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ti
authors.initials: T
authors.lastname: Lu
authors.affiliation: Department of Psychiatry, Yuanshan & Suao Branch, Taipei Veterans General Hospital, No. 301, Sec. 1, Subin Rd., Suao Township, Yilan County, 27047, Taiwan. PMC461002@yahoo.com.tw.
authors.forename: Pan-Ming
authors.initials: PM
authors.lastname: Chen
authors.affiliation: Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. pures1000@yahoo.com.tw.|Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, No.600, Sec. 2, Shixian Rd., West District, Chiayi City, 60090, Taiwan. pures1000@yahoo.com.tw.|Department of information management, National Chung-Cheng University, Chiayi, Taiwan. pures1000@yahoo.com.tw.
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D065635:Benign Paroxysmal Positional Vertigo / Q000453:epidemiology*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Anxiety disorder; Benign peripheral persistent vertigo; Risk factor