Sex and age differences in the management of dizziness/vertigo in primary care: a retrospective population-based...

Epidemiological studies on patients with dizziness/vertigo have shown a predominance of women. The objective of this study was to describe the diagnostic profile and resource usage in patients with dizziness/vertigo on the basis of age and sex and estimate the cumulative incidence of specific and nonspecific diagnoses in primary care (PC).

A cross-sectional descriptive study was conducted with 20 PC teams in southern Barcelona (Catalonia, Spain). Diagnosis records related to vertigo (specific and nonspecific diagnoses), age, sex, nationality, and the socioeconomic deprivation index of the population during 2019 were analysed. Descriptive analysis of the variables, bivariate analysis by sex, and stratification by age, and multivariate models were performed.

A total of 546,136 patients aged over 14 years were included, with a cumulative incidence of dizziness/vertigo of 2.86% (95% CI: 2.82-2.91). A total of 90.0% of the diagnoses were nonspecific, with dizziness/vertigo (74.4% of total diagnoses) being the most frequent. The most common specific diagnosis was benign paroxysmal positional vertigo (BPPV) (9.3% of the total diagnoses). Antivertiginous drugs were prescribed in 76.3% of specific cases and 60.58% of nonspecific cases. Women accounted for 66.7% of dizziness/vertigo diagnoses, but no significant sex-based differences were found in diagnostic coding. In nonspecific cases, women under 50 years were referred to neurology more often than men were (2.3% vs. 1.4%, p=0.030), whereas women over 50 years received more betahistine (52.9% vs. 47.1%, p<0.001, ages 51-75; 49.0% vs. 44.2%, p=0.016, over 75). Multivariate analysis revealed increased neurology referrals for nonspecific diagnoses in older individuals and in men over 75 years of age, whereas specific diagnoses were associated with greater referrals to otorhinolaryngology and greater drug usage.

There is a predominance of nonspecific diagnoses in PC, primarily affecting women who receive more treatments and neurology referrals for nonspecific diagnoses. For specific diagnoses, no differences in resource usage were observed between sexes.