Physical frailty and the risk of peripheral vertigo: evidence from the UK Biobank cohort

Peripheral vertigo is a common clinical condition that can substantially impair patients' balance and disrupt their daily and social activities. In some patients, symptoms may persist or recur and may be accompanied by auditory dysfunction or psychological problems, thereby imposing a considerable burden on individuals, families, and healthcare systems. Physical frailty, a prevalent clinical syndrome marked by reduced physiological reserve and increased stress vulnerability, is closely linked to various age-related functional impairments. Nevertheless, the specific association between physical frailty and peripheral vertigo risk remains unclear. This study aimed to explore this relationship using large-scale population-based data from the UK Biobank (UKB).

Based on UKB data, this retrospective cohort study enrolled 489,266 participants. Baseline frailty was assessed using the validated Fried phenotype encompassing five core components. Incident peripheral vertigo was defined using ICD-10 codes H810, H811, H812, and H813 based on hospital inpatient records. Multivariable Cox proportional hazards models and restricted cubic spline analyses were used to evaluate independent associations and dose-response trends, while subgroup analyses were conducted to explore sex-based heterogeneity.

During a median follow-up of 13.2 years, 2,802 new peripheral vertigo cases were identified. After full covariate adjustment, pre-frailty (HR = 1.36, 95% CI: 1.26-1.48) and frailty (HR = 2.05, 95% CI: 1.77-2.37) were independently associated with increased peripheral vertigo risk. A significant linear dose-response relationship was observed, with each one-point increment in frailty score increasing vertigo risk by 24% (95% CI: 19-29%). All five frailty components were independently associated with an increased risk of peripheral vertigo (all p < 0.001). Subgroup analyses verified a prominent sex interaction, with a stronger adverse effect of frailty in females.

Pre-frailty and physical frailty were independently and dose-dependently associated with an increased risk of incident peripheral vertigo, with all five frailty components showing significant associations with peripheral vertigo risk. The detrimental association is significantly modified by sex and more pronounced in females. This study provides novel population-based evidence supporting the potential value of frailty assessment in identifying individuals at elevated risk of peripheral vertigo, especially among females.